rowid,facility_name,facility_id,address,city,state,zip,inspection_date,deficiency_tag,scope_severity,complaint,standard,eventid,inspection_text,filedate
1,CEDARS NURSING CARE CENTER,205003,630 OCEAN AVENUE,PORTLAND,ME,4112,2018-02-08,842,D,0,1,9O8T11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to maintain complete documentation of a medical record related to pain management for 1 of 19 sampled residents (#15). Finding: On 2/6/18, in review of Resident #15's record, the surveyor noted the resident was admitted on [DATE] and diagnosed with [REDACTED]. Resident #15's care plan, originally created 3/28/13, indicated he/she has non-pharmalogical pain management interventions available, such as cold-heat application. According to the electronic Treatment Administration Record (eTAR), Resident #15's pain was assessed every shift in the months of (MONTH) and every shift, thus far in February. According to documentation in the eMAR, the Resident reported pain in (MONTH) on 11 of 93 shifts, with pain ranging from 2-7 out of 10 and in (MONTH) on 6 of 15 shifts, pain ranging from 2-4 out of 10. According to the eMAR, [MEDICATION NAME] was not administered in (MONTH) and February, and there was no documentation to reflect the medication was offered and/or refused on the dates the Resident reported pain, nor was there documentation of other interventions offered and administered or refused to provide comfort. On 2/6/18 at 10:30 a.m., in an interview, the surveyor confirmed the finding with the Director of Nursing and the Shapiro Neighborhood Nurse Manager.",2020-09-01
2,CEDARS NURSING CARE CENTER,205003,630 OCEAN AVENUE,PORTLAND,ME,4112,2018-02-08,880,D,0,1,9O8T11,"Based on observation and interviews, the facility failed to disinfect multi-use blood glucose meters in accordance with CDC (Center for Disease Control) recommendations: the meter should cleaned/disinfected per manufacturer's instructions on 1 of 3 units. Finding: During an interview with the surveyor on 2/17/18 at 10:00 a.m., a Registered Nurse (RN) on the Black[NAME]Unit demonstrated disinfecting the multi-resident use blood glucose meter with an alcohol wipe. On 2/7/18 at 10:10 a.m., the RN/Nurse Manager confirmed that alcohol wipes were used for the multi-use glucose meter, stating this was following the manufacturer's instructions. Review of the CDC recommendations regarding multi-use blood glucose meters indicates if blood glucose meters must be shared, the device should be cleaned and disinfected after each use, per manufacturer's instructions, to prevent carry-over of blood and infectious agents. If the manufacture does not specify how the device should be cleaned and disinfected then it should not be shared. Review of the Manufacturer's instructions regarding multi-use blood glucose meters gives two options for disinfecting. Disinfection can be completed by using a commercially available EPA- registered disinfectant or germicide wipe. or To disinfect the meter, dilute 1 ml of household bleach (5%-6% sodium hypochlorite solution) in 9 ml of water to achieve a 1:10 dilution (final concentration of 0.5%-0.6% sodium hypochlorite). Then use the dampened paper towel to thoroughly wipe down the meter. Note there are commercially available 1;10 bleach wipes from a variety of manufactures. On 2/8/18 at 12:45 p.m., in an interview, the surveyor confirmed the finding with the Director of Nursing and Nurse Manager/Infection Control Nurse.",2020-09-01
3,CEDARS NURSING CARE CENTER,205003,630 OCEAN AVENUE,PORTLAND,ME,4112,2018-02-08,883,D,0,1,9O8T11,"The facility failed to ensure 1 of 5 residents (#24) reviewed for immunizations included documentation in the medical record to indicate the resident or legal representative was provided education and offered the pneumococcal immunization. Finding: On review of Resident #24's clinical record, the surveyor could not locate evidence the resident was offered or given the pneumococcal immunization, Pneumococcal Conjugate Vaccine (Prevnar13). On 2/8/18 at 1:55 p.m., in an interview, the surveyor confirmed the finding with the Director of Nursing.",2020-09-01
4,CEDARS NURSING CARE CENTER,205003,630 OCEAN AVENUE,PORTLAND,ME,4112,2020-02-13,637,D,0,1,YYCN11,"Based on interview and record review, the facility failed to conduct a comprehensive Minimum Data Set 3.0 (MDS 3.0) assessment within 14 days after a resident experienced a significant change of condition and hospice services were initiated for 2 of 4 sampled residents (Residents #39 and #81). Findings: 1. On review of Resident #81's clinical record, a surveyor noted the resident was receiving hospice services, initiated on 11/19/19. On further review, the surveyor noted the most recent Minimum Data Set 3.0 (MDS 3.0) assessment was a quarterly assessment completed on 10/28/19. The most recent comprehensive MDS was dated 5/13/19 and no comprehensive MDS 3.0 assessment was completed with 14 days of the initiation of hospice services. On 2/12/20 at 12:00 PM, in an interview with the Nurse Informatics Specialist, Registered Nurse, the surveyor confirmed a significant change of condition MDS 3.0 was not completed. 2. On review of Resident #39's clinical record, a surveyor noted the resident was receiving hospice services, initiated on 8/5/19. On further review, the surveyor noted the most recent Minimum Data Set 3.0 (MDS 3.0) comprehensive assessment was completed on 1/3/20, which did not indicate receipt of hospice services, and no comprehensive MDS 3.0 was completed within the 14 days of initiation of hospice services. On 2/12/20 at 11:00 AM., a surveyor confirmed the finding in an interview with the Director of Nursing.",2020-09-01
5,CEDARS NURSING CARE CENTER,205003,630 OCEAN AVENUE,PORTLAND,ME,4112,2019-02-28,582,B,0,1,51MR11,"Based on interview and clinical record review, the facility failed to ensure the Skilled Nursing Facility Advance Beneficiary Notices (SNFABN) were provided to 2 of 3 residents whose Medicare Part A services were discontinued (Residents #46 and #74). Findings: 1. On review of Resident #46's clinical record, a surveyor noted the resident received Medicare Part A services that ended on 1/17/19 but the surveyor could not locate evidence that the required Skilled Nursing Facility Advance Beneficiary Notice (SNFABN) was provided to the resident so that he/she could make an informed decision to continue receiving the skilled services that may not be paid for by Medicare and assume financial responsibility. 2. On review of Resident #74's clinical record, a surveyor noted the Resident, received Medicare Part A services that ended on 1/14/19 but the surveyor could not locate evidence that the required Skilled Nursing Facility Advance Beneficiary Notice (SNFABN) was provided to the resident so that he/she could make an informed decision to continue receiving the skilled services that may not be paid for by Medicare and assume financial responsibility. On 2/26/19 at 11:15 a.m., in an interview with the Licensed Social Worker, the surveyor confirmed that SNFABNs were not issued prior to the end of Medicare Part A services.",2020-09-01
6,CEDARS NURSING CARE CENTER,205003,630 OCEAN AVENUE,PORTLAND,ME,4112,2019-02-28,758,E,0,1,51MR11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interviews, the facility failed to ensure monitoring for side effects of antipsychotic medications are completed timely for 3 of 5 residents reviewed for unnecessary medications ( #19, #38 and #72). Findings: The facility's Antipsychotic Medication Use, Policy and Implementation indicated: An AIMS (Abnormal Involuntary Movement Scale) test will be performed on any resident taking antipsychotic medication every 6 months. 1. On 2/26/19 at 11:00 a.m. during a review of Resident #19's clinical record a surveyor noted an order for [REDACTED]. On 2/26/19 at 12:05 p.m., in an interview with a Registered Nurse, Informatics Specialist, the surveyor confirmed that the AIMS test had not been completed since 2/7/18. 2. On 2/26/19 during a review of Resident #38's clinical record, the surveyor noted a physician's orders [REDACTED]. Resident #38's current physician orders [REDACTED]. The clinical record revealed an AIMS test was not completed. 3. On 2/26/19 during a review of Resident #72's clinical record, a surveyor noted a physician's orders [REDACTED]. Resident #72's current physician orders [REDACTED]. The clinical record revealed an AIMS test was not completed. On 2/26/19 at 11:21 a.m., during an interview with a Registered Nurse/Informatics Specialists, a surveyor confirmed the above findings",2020-09-01
7,CEDARS NURSING CARE CENTER,205003,630 OCEAN AVENUE,PORTLAND,ME,4112,2019-02-28,761,D,0,1,51MR11,"Based on observation and interviews the facility failed to maintain secured medications on 1 of 4 days of survey. Finding: On 2/27/19 at 8:38 a.m., a surveyor observed a Registered Nurse (RN) place a medication cup with a tablet in the cup on top of the medication cart; he/she then walked into the dining room leaving the medication cup containing the tablet unattended and not within view. The RN confirmed the medication was left unattended upon return to the cart. On 2/27/19 at 3:13 p.m., in an interview with the Director of Nursing, a surveyor confirmed the above findings.",2020-09-01
8,CEDARS NURSING CARE CENTER,205003,630 OCEAN AVENUE,PORTLAND,ME,4112,2019-02-28,812,E,0,1,51MR11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and interviews, the facility failed to ensure that food readily available for resident use in refrigerators and dry food storage areas was labeled, dated, and removed after the expiration date during 2 of 4 days of survey ([DATE] and [DATE]); and to ensure that residents are served food in a sanitary manner on 1 of 10 dining observations ([DATE]). Findings: 1. On [DATE] at 08:45 a. m. during a tour of the kitchen, a surveyor and the Food Service Director (FSD) observed the following expired food items in the dry storage area, and in the white refrigeration unit: - 5 packages of English muffins with a sell by date on package of [DATE]; and -3 opened containers of thickened flavored drink (1 orange; 1 grape; 1 lemon water) with no opened date on the container. In an interview with the surveyor on [DATE], at approximately 10:00 a. m., the FSD indicated confirmation from the manufacturer that the thickened liquids can be safely used for 7 days after opening and bread for 3 days after the sell-by date on the packaging. 2. On [DATE], at 9:30 a. m., a surveyor and the unit manager observed the Black/Wolf Unit resident snack refrigerator to contain: -1 small styrofoam container of food, without a resident name and with a hand-written date of ,[DATE] on the package. On [DATE], at approximately 9:45 a. m., a surveyor and the unit manager observed the Shapiro Unit resident snack refrigerator and dry food storage snack cabinet to contain: -1 cardboard take-out food container, and 4 plastic take-out food containers with a hand written dated of ,[DATE] but with no resident name identified on the packages; -1 opened bag of wheat bread, with best by date stamp of [DATE]; and -2 opened packages of undated English muffins with no expiration date. On [DATE], at approximately 10:15 a. m., a surveyor and the unit manager observed the Leibowitz unit Resident snack refrigerator to contain 2 unopened, half gallon sized containers of orange juice with a manufacture date stamp of (MONTH) 14, 2019 on the container. The side of the label indicated the contents can be consumed through the date stamped on the carton. The surveyor confirmed the findings at the time of the observations. 3. On [DATE] at 12:15 p. m., in the first floor main dining room, during the lunch meal service, a surveyor observed a dietary aide pick up and move two soiled drinking cups and a bowl from a resident, while holding onto the top rim of the cups with his/her bare fingers. The dietary aide continued, without cleaning his/her hands, to serve a clean plate of food to another resident and, with bare hands, held down the sandwich bun while cutting it, then repositioned the sandwich meat on the bun. The surveyor intervened and the plate was removed from the Resident prior to consumption. At 12:20 p.m., in an interview with the dietary aide, infection control practices were discussed and the dietary aide was provided education on hand hygiene during meal service and use of gloves when touching ready to eat food. In an interview on [DATE], at 1:00 p. m., the surveyor and the Food Service Director discussed the findings for kitchen and meal service. The surveyor confirmed the findings.",2020-09-01
9,HIBBARD SKILLED NURSING & REHABILITATION CENTER,205004,1037 WEST MAIN STREET,DOVER FOXCROFT,ME,4426,2019-01-31,609,D,1,0,U8NG11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on review of the facility reportable incident form and interview, the facility failed to ensure staff reported a violation involving Resident Abuse was reported in a timely manner for 1 of 1 residents reveiwed (Resident #8). Finding: The facility's First [MEDICATION NAME] HealthCare Resident Abuse Prevention Policy & Procedure indicated on page 2, Section 5 Reporting/Response, under letter a. directs that mandated reporters will follow the guidelines in the Department of Human Services, Bureau of Elder and Adult Services (BEAS) publication Abuse, Neglect and Exploitation in Licensed Facilities. They will concurrently report the incident to the Administrator and the Administrator, Adult Protective Services and DHHS Licensing and Certification will be notified immediately of any suspected abuse, neglect or exploitation. The facilities Nursing Facility Reportable Incident Form indicates the incident occurred on 10/14/18 at 12:15 p.m. and the staff member did not report it to her supervisor until 10/15/18 when she came to work at 11:20 a.m. On 1/28/19 at 11:40 a.m. during an interview with the surveyor the Activity Aide, a witness to the incident, stated that Resident #8 was roaming that day and Certified Nursing Assistant (CNA) #1 was feeding another resident. Resident #8 went to another table to take their food. Resident #8 was screaming; CNA #1 took him/her by the arm and plunked him/her in the chair forcefully at the table. Resident #8 was screaming and CNA #1 was yelling in his/her face you're not gonna out do me yelling and then CNA #1 held his/her arms down on his/her lap for 2-3 minutes. After a few minutes, Resident #8 settled and CNA #1 went back to feeding but she kept yelling at Resident #8 saying you can't do what you want to do, you can't take people's lunch. This happened on Sunday and I knew CNA #1 wasn't working the next day. I didn't know I should have told anyone. I came in first thing in the morning, on Monday, and told my supervisior. I have been educated and written up for not reporting it sooner and I now know to report it right away, and I will. On 1/28/18 at approximately 2:30 p.m. a.m. a surveyor confirmed during an interview with the Administrator that an allegation of abuse was not immediately reported to supervisory staff which allowed CNA #1 to continue to work with Resident #8 until 2:45 p.m. on 10/14/18.",2020-09-01
10,HIBBARD SKILLED NURSING & REHABILITATION CENTER,205004,1037 WEST MAIN STREET,DOVER FOXCROFT,ME,4426,2019-01-31,644,D,0,1,U8NG11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record reviews and interviews, the facility failed to ensure a Pre-Admission Screening and Resident Review (PASRR) was completed when a new mental illness was diagnosed , for 1 of 3 sampled residents reviewed for PASRR (#4). Finding: On 6/20/18, the Physician wrote an order to change the [DIAGNOSES REDACTED]. Review of Resident #4's clinical record revealed the only PASRR completed for Resident #4 was completed 12/1/2003. On 1/29/19 at 11:27 a.m., during an interview with a surveyor, a Licensed Social Worker (LSW) stated that she was unable to find a new PASRR for Resident #4 and she was unaware that Resident #4 had a new mental health [DIAGNOSES REDACTED]. On 1/29/19 at 12:32 p.m., during an interview with a surveyor, the RAI (Resident Assessment Instrument) Coordinator stated that she was unaware of a facility process on notifying the LSW when a resident is diagnosed with [REDACTED]. The surveyor confirmed during both of these interviews that the resident's medical record lacked evidence that a PASRR Level I screen was completed to reflect the resident's new [DIAGNOSES REDACTED].",2020-09-01
11,HIBBARD SKILLED NURSING & REHABILITATION CENTER,205004,1037 WEST MAIN STREET,DOVER FOXCROFT,ME,4426,2019-01-31,684,D,0,1,U8NG11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record reviews and interview, the facility failed to follow physician orders [REDACTED]. (Resident #27, #80, #279, and #4) Findings: The facility Administering Medications Policy indicates the resident's medications must be administered within one hour of their prescribed times, unless otherwise specified. 1. Resident #27's physician order [REDACTED]. [MEDICATION NAME] (nasal allergy medication) Artificial Tears (eye drop moisturizing medication) The medications were given on 1/30/19 at 8:47 a.m., 47 minutes after the scheduled parameter of medication administration within one hour of their prescribed times. 2. Resident #80's physician order [REDACTED]. [MEDICATION NAME] (pain medication) Aspirin, delayed release (medication to prevent [MEDICAL CONDITION]) Senna plus (medication to prevent constipation) Vitamin D (supplement) The medications were given on 1/30/19 at 8:59 a.m., 59 minutes after the scheduled parameter of medication administration within one hour of their prescribed times. 3. Resident #279's physician order [REDACTED]. Vitamin D3 (supplement) [MEDICATION NAME] Oxalate (depression and anxiety medication) [MEDICATION NAME] (medication to prevent constipation) [MEDICATION NAME] (blood pressure medication) Senna (medication to prevent constipation) [MEDICATION NAME] (a pain patch applied to skin) [MEDICATION NAME] (allergy medication) Potassium Chloride Extended Release (supplement) The medications were given on 1/30/19 at 9:08 a.m., 1 hour and 8 minutes after the scheduled parameter of medication administration within one hour of their prescribed times. 4. Resident #4's physician order [REDACTED]. Calcium (supplement) [MEDICATION NAME] (blood pressure medication) [MEDICATION NAME] (medication to prevent constipation) Senna S (medication to prevent constipation) [MEDICATION NAME] (pain medication) [MEDICATION NAME] Sodium (medication to prevent constipation) [MEDICATION NAME] (medication to prevent nausea) [MEDICATION NAME] (anxiety medication) The medications were given on 1/31/19 at 8:20 a.m., 20 minutes after the scheduled parameter of medcation administration within one hour of their prescribed times On 1/31/19 at 11:20 a.m., in an interview with the Director of Nursing Services, a surveyor confirmed the above findings.",2020-09-01
12,HIBBARD SKILLED NURSING & REHABILITATION CENTER,205004,1037 WEST MAIN STREET,DOVER FOXCROFT,ME,4426,2019-01-31,812,E,0,1,U8NG11,"Based on observations and interviews, the facility failed to ensure the kitchen floors were clean and free of dirt and grime on 4 of 4 days of survey (1/28/19, 1/29/19, 1/30/19 and 1/31/19), failed to label mighty shakes and nutritional juices with a thaw date on 1 of 4 days of survey (1/28/19), and failed to allow plates and small bowls to air dry before stacking them on a serving counter on 1 of 4 days of survey (1/29/19). Findings: On 1/28/19 at 11:00 a.m. during the initial tour of the kitchen, a surveyor observed the kitchen floors were very dirty with built up dirt and grime. Under the cook stove and the convection oven, the floors were blackened with dirt and grime and the grout lines of the tiled floor were filled with built up black grime and under the prep table and bakers table there was a buildup of grime. Under the steel table on the left side of the steamtable, the floor had what appeared to be chips, french fries, and dried on juice. In the walk-in refrigerator, there were 12 thawed mighty shake nutritional drinks and 15 thawed nutritional juices on a tray not labeled with a thaw date; the storage and handling instructions on the cartons was to use within 14 days after thawing. On 1/29/19 at 9:15 a.m., during a second tour of the kitchen, a surveyor observed the kitchen floors were still dirty with built up dirt and grime. On the steel table on the left side of the steamtable, a surveyor and the Food Service Supervisor (FSS ) observed 8 bread plates and 16 small bowls (monkey dishes) wet stacked. The FSS removed all the dishes and instructed staff to allow to air dry before stacking on the table. On 1/30/19 at 10:00 a.m., during a follow-up tour of the kitchen, a surveyor observed the kitchen floors had been swept and mopped but a buildup of dirt and grime remain in the grout lines of the tiled floor and under the cook stove and convection oven. The FSS stated they are in the process of working with Maintenance to find a product to clean the floors. On 1/31/19 at 8:30 a.m., during a follow-up tour of the kitchen, a surveyor observed the kitchen floors still have a dirt and grime build up in the grout lines of the tiled floor. The surveyor confirmed these findings with the FSS at the time of the observations.",2020-09-01
13,HIBBARD SKILLED NURSING & REHABILITATION CENTER,205004,1037 WEST MAIN STREET,DOVER FOXCROFT,ME,4426,2018-02-08,684,E,0,1,RFBP11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to follow Physician orders [REDACTED].#27, #67, #40) currently residing in the facility and 1 of 2 discharged Residents (#80). Findings: 1 On 2/8/18, a review of Resident #27's clinical record was completed. Resident #27 had a Physician lab order to draw a Basic Metabolic Panel (BMP) on 1/2/18. On 2/8/18 at 9:30 a.m., in an interview with the surveyor, the Long Term Care (LTC) Nurse Manager, stated that she was unable to find a lab result for the BMP and could not find evidence that it was drawn. The LTC Manager stated that she would place it in the lab book to be drawn. The surveyor confirmed this finding with the LTC Manager at this time. 2. Resident #67 had a written physician order, dated 2/1/18, to obtain a Urine reflex lab and to stop the [MEDICATION NAME] orders. There is no evidence in the clinical record that the urine lab was collected and that the [MEDICATION NAME] orders were discontinued. On 2/6/18 at 12:18 p.m., during an interview with a surveyor, the Charge Nurse stated that the [MEDICATION NAME] had not be discontinued and the urine test has not been completed, this order was overlooked. The surveyor confirmed this finding with the Charge Nurse at this time. 3. Resident #40's clinical record contained a Physician order, dated 1/3/18, for [MEDICATION NAME] (an antibiotic) with the strength of 200 milligrams (mgs) per 5 milliliters (mls) and the directions to administer 12.5 mls today then 6.25 mls daily for 4 days. Resident #40's Medication Administration Record [REDACTED]. The physician order [REDACTED].#40 did not get the proper dose of medication as ordered by the physician. The surveyor confirmed this finding at this time. 4. On 2/8/18, a review of Resident #80's closed clinical record was completed. Resident #80's clinical record contained a Physician order, dated 11/20/17, for [MEDICATION NAME] 4 milligrams (mg) by mouth (PO) every 6 hours as needed (PRN) for nausea x 2 weeks (12/3/17). Review of Resident #80's Medication Administration Record [REDACTED]#80's clinical record and were unable to find another Physician order [REDACTED].",2020-09-01
14,HIBBARD SKILLED NURSING & REHABILITATION CENTER,205004,1037 WEST MAIN STREET,DOVER FOXCROFT,ME,4426,2018-02-08,697,E,0,1,RFBP11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record reviews and interviews, the facility to document why pain medication was administered and/or failed to monitor and document the effectiveness of the pain medication for 4 of 6 residents reviewed for pain management (#65, #179, #180, #228). Findings: 1. On 2/6/18 at 10:09 a.m., in an interview with the surveyor, Resident #65 was showing physical signs of pain through facial grimacing and verbalizing pain. Resident #65 stated the pain is inside near his/her private area. Resident #65 stated to the surveyor that he/she told the nurse that he/she is experiencing pain. Documentation in the physician order [REDACTED].#65 had an order for [REDACTED].#65's Medication Administration Record [REDACTED]. On 2/6/18, at approximately 12:30 p.m., the resident was observed resting quietly in bed. On 2/8/18, a review of the MAR indicated [REDACTED] On 1/31/18 at 3:57 a.m., Resident #65 received Tylenol 650 mgs for the complaint of having pain at a 5-6 pain level. There was no evidence that the pain medication, Tylenol, was monitored for effectiveness after being administered. On 1/25/18 at 4:54 p.m., Resident #65 received Tylenol 650 mgs for the complaint of having pain at a 5-6 pain level. There was no evidence that the pain medication, Tylenol, was monitored for effectiveness after being administered. On 12/8/17 at 4:18 p.m., Resident #65 received Tylenol 650 mgs. There was no documentation as to why the Tylenol was administered. There was no evidence that the pain medication, Tylenol, was monitored for effectiveness after being administered. On 10/24/17 at 6:12 p.m., Resident #65 received Tylenol 650 mgs. There was no documentation as to why the Tylenol was administered. There was no evidence that the pain medication, Tylenol, was monitored for effectiveness after being administered. On 10/3/17 at 5:10 p.m., Resident #65 received Tylenol 650 mgs. There was no documentation as to why the Tylenol was administered. There was no evidence that the pain medication, Tylenol, was monitored for effectiveness after being administered. On 9/22/17 at 9:10 p.m., Resident #65 received Tylenol 650 mgs. There was no documentation as to why the Tylenol was administered. There was no evidence that the pain medication, Tylenol, was monitored for effectiveness after being administered. On 9/21/17 at 6:15 a.m., Resident #65 received Tylenol 650 mgs for the complaint of having pain at a 5-6 pain level for lower abdominal area. There was no evidence that the pain medication, Tylenol, was monitored for effectiveness after being administered. On 9/17/17 at 11:13 a.m., Resident #65 received Tylenol 650 mgs. There was no documentation as to why the Tylenol was administered. There was no evidence that the pain medication, Tylenol, was monitored for effectiveness after being administered. On 2/8/18 at 1:45 p.m., in an interview with the Long Term Care Unit Manager, the surveyor confirmed the above findings. 2. Resident #179 had physician orders [REDACTED]. On 1/30/18 at 9:00 p.m., Resident #179 received [MEDICATION NAME] two 325 mgs tablets for pain level of 7-8 intense, the clinical record lacks documentation of the effectiveness of this medication. On 1/31/18 at 3:53 p.m., Resident #179 received [MEDICATION NAME] 5 mgs for pain 9-10, the clinical record lacks documentation of the effectiveness of this medication. On 2/1/18 at 11:16 a.m., resident received [MEDICATION NAME] aerosol solution 2 puffs for shortness of breath (SOB), the clinical record lacks documentation of the effectiveness of this medication. On 2/2/18 at 1:31 p.m., the resident received [MEDICATION NAME] 5 mgs for general discomfort, the clinical record lacks documentation of the effectiveness of this medication. On 2/5/18 at 8:38 a.m., [MEDICATION NAME] 5 mgs for pain level of 10, clinical record lacks documentation of the effectiveness of this medication. At 12:27 p.m. second dose of [MEDICATION NAME] 5 mgs was given po for a pain level of 8, clinical record lacks documentation of the effectiveness of this medication. On 2/6/18 at 8:30 a.m. [MEDICATION NAME] 5 mgs was given for pain level of 8, clinical record lacks documentation of the effectiveness of this medication. A surveyor confirmed these findings with the skilled nurse manager on 2/8/18 at 1:00 p.m. 3. Resident #180 had Physician orders [REDACTED]. On 1/16/18 at 8:52 a.m. Tylenol Extra Strength 1000 mgs was given for pain level of 3, the clinical record lacks documentation of the effectiveness of this medication. On 1/19/18 at 10:07 a.m. [MEDICATION NAME] 4 mgs was given for pain level of 10, the clinical record lacks documentation of the effectiveness of this medication. On 1/20/18 at 7:42 a.m. [MEDICATION NAME] 4 mgs was given for pain level of 5-6, the clinical record lacks documentation of the effectiveness of this medication On 1/20/18 at 3:59 p.m. [MEDICATION NAME] 4 mgs was given for pain level of 5-6, the clinical record lacks documentation of the effectiveness of this medication On 1/22/18 at 8:38 p.m. [MEDICATION NAME] 4 mgs was given for pain level of 7-8, the clinical record lacks documentation of the effectiveness of this medication On 1/24/18 at 8:32 a.m. [MEDICATION NAME] 4 mgs was given for general discomfort, the clinical record lacks documentation of the effectiveness of this medication. On 1/26/18 at 12:59 p.m. [MEDICATION NAME] 4 mgs was given for pain level of 10, the clinical record lacks documentation of the effectiveness of this medication. On 1/26/18 at 9:42 p.m. [MEDICATION NAME] 4 mgs was given for general discomfort level of 8, the clinical record lacks documentation of the effectiveness of this medication On 1/27/18 at 8:42 a.m. [MEDICATION NAME] 4 mgs was given with no indication of pain level and the clinical record lacks documentation of the effectiveness of this medication. On 1/28/18 at 3:08 p.m. [MEDICATION NAME] 4 mgs was given for pain level of 8, the clinical record lacks documentation of the effectiveness of this medication On 1/31/18 at 3:12 p.m. [MEDICATION NAME] 4 mgs was given for pain level of 7-8, the clinical record lacks documentation of the effectiveness of this medication. On 2/1/18 at 8:35 p.m. [MEDICATION NAME] 4 mgs was given for general discomfort, the clinical record lacks documentation of the effectiveness of this medication On 2/2/18 at 2:35 p.m. and at 8:05 p.m. [MEDICATION NAME] 4 mgs was given for pain level of 10 and 7, the clinical record lacks documentation of the effectiveness of this medication On 2/4/18 at 12:03 a.m. [MEDICATION NAME] 4 mgs was given for pain level of 7, the clinical record lacks documentation of the effectiveness of this medication On 2/4/18 at 4:23 p.m. [MEDICATION NAME] 325 mgs was given for pain with no level indicated and the clinical record lacks documentation of the effectiveness of this medication. On 2/5/18 at 8:57 a.m. [MEDICATION NAME] 325 mgs was given for pain with no level indicated and the clinical record lacks documentation of the effectiveness of this medication. A Surveyor confirmed these findings with the Administrator on 2/8/18 at 4:22 p.m. 4. On 2/8/18 Resident #228's clinical record was reviewed. The clinical record contained an order, dated 2/1/18, for [MEDICATION NAME] 30 milligrams (mgs) every 4 hours as needed (PRN) for pain and an order for [REDACTED]. On 2/8/18 at 7:42 a.m., Resident #228's Electronic Medication Administration Record [REDACTED]. There was no documentation as to what the pain level was prior to the administration. In addition, the effectiveness was documented as effected at 7:42 a.m., immediately after administration. On 2/5/18 at 12:48 p.m., Resident #228's EMAR contained documentation that Resident #228 received [MEDICATION NAME] 30 mgs for general discomfort. There was no documentation as to what the pain level was prior to the administration. In addition, the effectiveness was documented as effective at 12:49 p.m., immediately after administration. On 2/8/18 at 1:15 p.m., during an interview with a surveyor, the Charge Nurse that administered both doses stated that he should have waited an hour before evaluating the Resident for effectiveness of the medication and he did not reassess the Resident. On 2/7/18 at 1:13 a.m., Resident #228's EMAR contained documentation that Resident #228 received [MEDICATION NAME] 30 mgs for pain at a level of 5-6, distressing all over. The clinical record lacked evidence of monitoring the effectiveness of this medication. On 2/6/18 at 8:07 p.m., Resident #228's EMAR contained documentation that Resident #228 received [MEDICATION NAME] 30 mgs for pain at a level of 5-6, distressing all over. The clinical record lacked evidence of monitoring the effectiveness of this medication. On 2/6/18 at 12:01 p.m., Resident #228's EMAR contained documentation that Resident #228 received [MEDICATION NAME] 30 mgs. The clinical record lacked evidence of why the medication was given and monitoring the effectiveness of this medication. On 2/5/18 at 10:12 p.m., Resident #228's EMAR contained documentation that Resident #228 received [MEDICATION NAME] 5 mg for pain. The clinical record lacked evidence of a pain assessment pain assessment prior to administration and monitoring the effectiveness of this medication. On 2/5/18 at 8:00 a.m., Resident #228's EMAR contained documentation that Resident #228 received [MEDICATION NAME] 5 mg for pain level of 10 in the back. The clinical record lacked evidence of monitoring the effectiveness of this medication. On 2/8/18 at 1:16 p.m., during an interview with the Administrator, the surveyor confirmed staff are not monitoring pain prior to administration of pain medication and/or monitoring for the effectiveness after administration of the pain medication.",2020-09-01
15,HIBBARD SKILLED NURSING & REHABILITATION CENTER,205004,1037 WEST MAIN STREET,DOVER FOXCROFT,ME,4426,2018-02-08,732,C,0,1,RFBP11,"Based on observations and interview, the facility failed to post the current nurse staffing schedule in a prominent place that is readily accessible to residents and visitors. Finding: On 2/5/18, 2/6/18, 2/7/18 and 2/8/18, three surveyors observed that the daily nurse schedule was not posted in an area that both residents and visitors could read and have access too. Two surveyors observed that the nurses daily schedule was on a small dry board on the counter of the reception desk upon entrance to the facility. It was not clearly visible to visitors and residents. On 2/8/18 at 10:20 a.m., in an interview with the Director of Nursing, the surveyor confirmed this finding.",2020-09-01
16,HIBBARD SKILLED NURSING & REHABILITATION CENTER,205004,1037 WEST MAIN STREET,DOVER FOXCROFT,ME,4426,2018-02-08,755,E,0,1,RFBP11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, Medication Administration Record [REDACTED]. The facility also failed to ensure a Physician ordered medication was available for use for a Resident (#40). Findings: 1. On 2/7/18 at 1:14 p.m., a surveyor observed in the refrigerator in the Main Building medication storage room, an opened bottle of [MEDICATION NAME] Suspension for Resident #40 with an expiration date of 2/4/17. The surveyor confirmed this finding with the charge nurse at the time of the observation. The medication was discarded at time of observation. On 2/7/18 at 1:55 p.m., during an interview with a surveyor, the Charge Nurse stated this was the only bottle of [MEDICATION NAME] Suspension for Resident #40 available for use. Resident #40's MAR indicated [REDACTED]. 2. On 2/8/18 at 2:08 p.m., a surveyor observed in the Tra[NAME]Wing medication cart, a bottle of [MEDICATION NAME] Sodium 220 milligrams each tablet, available for use with an expiration date of 1/31/18. The surveyor confirmed this finding with the Long Term Care Nurse Manager at the time of the observation. The medication was discarded at time of observation. 3. Resident #40's clinical record contained a Physician order, dated 1/3/18, for [MEDICATION NAME] (an antibiotic) with the strength of 200 milligrams (mgs) per 5 milliliters (mls) and the directions to administer 12.5 mls today then 6.25 mls daily for 4 days. Resident #40's MAR indicated [REDACTED]. On 2/8/18 at 3:14 p.m., in an interview with the surveyor, the Administrator stated that the medication was not available for Resident #40 until 1/6/18. On 2/8/18 at 3:14 p.m., in an interview with the Administrator, the surveyor confirmed the above findings.",2020-09-01
17,HIBBARD SKILLED NURSING & REHABILITATION CENTER,205004,1037 WEST MAIN STREET,DOVER FOXCROFT,ME,4426,2018-02-08,770,E,0,1,RFBP11,"Based on record reviews and interviews, the facility failed to ensure Physician lab orders were completed as ordered for 2 of 18 sampled Residents (#27, #67). Findings: 1. On 2/8/18, a review of Resident #27's clinical record was completed. Resident #27 had a Physician lab order to draw a Basic Metabolic Panel (BMP) on 1/2/18. On 2/8/18 at 9:30 a.m., in an interview with the surveyor, the Long Term Care (LTC) Nurse Manager, stated that she was unable to find a lab result for the BMP and could not find evidence that it was drawn. The LTC Manager stated that she would place it in the lab book to be drawn. The surveyor confirmed this finding at this time. 2. On 2/6/18, during a review of Resident #67's clinical record, Resident #67 had a Physician lab order, dated 2/1/18, for a urine reflux test. The surveyor was unable to find evidence of this test being completed. On 2/6/18 at 12:18 p.m., during an interview with a surveyor, the Charge Nurse stated that this test has not been completed and this order was overlooked. The surveyor confirmed this finding with the Charge Nurse at this time.",2020-09-01
18,HIBBARD SKILLED NURSING & REHABILITATION CENTER,205004,1037 WEST MAIN STREET,DOVER FOXCROFT,ME,4426,2018-02-08,842,D,0,1,RFBP11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure a Physician order [REDACTED].#40). In addition, based on interviews, record reviews, and Narcotic bound book pages review, the facility failed to ensure medications were documented on the Electronic Medication Administration record/ Treatment Administration Record (MAR/TAR) were documented when a pain medication was administered for 2 of 3 Residents whose Narcotic bound book pages were reviewed (#179, #180). Findings: 1. Resident #40's medication block orders and Medication Administration Record [REDACTED]. Resident #40 is NPO (nothing by mouth) and has an enteral feeding tube. On 2/8/18 at 3:14 p.m., in an interview with a surveyor, the Administrator stated that the route of medication administration should have been written as via enteral tube and not by mouth. The surveyor confirmed this finding with the Administrator at this time. Resident #40 has been receiving [MEDICATION NAME] correctly via enteral tube. 2 Resident #179 had a physician order [REDACTED].#179's clinical record review, the Narcotic bound book, on page 135, contained documentation that on 1/31/18 at 10:00 p.m. (2200) he/she received [MEDICATION NAME] 5 mg. The Electronic MAR/TAR and the nurse's notes for Resident #179 lacks evidence/documentation of the medication being administered. A surveyor confirmed this finding with the Skilled Unit Nurse Manager on 2/8/18 at 1:00 p.m. 3. Resident #180 had a physician order [REDACTED].#180's clinical record review, the Narcotic bound book page, 126, contained documentation that Resident #180 received [MEDICATION NAME] two 2 mg tablets on 1/15/18 at 4:30 p.m. and at 8:30 p.m. The Electronic MAR/TAR and the nurse's notes for Resident #180 lacks evidence/documentation of the medication being administered. On Page 127 of the Narcotic bound book, documentation indicated on 1/28/18 at 8:34 p.m. and 1/29/18 at 8:05 p.m. Resident #180 received a [MEDICATION NAME] 4 mg tablet. The Electronic MAR/TAR and the nurse's notes for Resident #180 lacks evidence/documentation of the medication being administered. A surveyor confirmed these findings with the Administrator on 2/8/18 at 4:22 p.m.",2020-09-01
19,HIBBARD SKILLED NURSING & REHABILITATION CENTER,205004,1037 WEST MAIN STREET,DOVER FOXCROFT,ME,4426,2019-12-17,600,D,1,0,96D111,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on record review, review of facility internal investigation, interviews, and information gathered during this investigation, it is determined that the facility neglected to ensure a resident's safety needs by letting the resident out of the facility unattended by a staff member for 1 of 1 opportunely (Resident #1). Finding: Documentation in Resident #1's clinical record indicates that the resident is on a Secured Unit and is diagnosed with [REDACTED]. Documentation in Resident #1's care plan dated 7/26/19, the resident has a history of falls, had impaired mobility, requires one staff member to assist to stand and assist with exercises. One assist is required when the resident is unsteady. The care plan indicates the resident losses balance easily and tends to close his/her eyes when walking due to double vision. On 8/2/19 early evening, Resident #1 asked C.N.[NAME] #1 if he/she could go out into the secured courtyard that is attached to the Secured Unit. C.N.[NAME]#1 let the resident out into the courtyard unattended by staff. On 12/17/19 at 10:00 a.m., in an interview with the Administrator, he stated that at that time (8/2/19), the courtyard was under construction. Parts of the secure fence around the courtyard was down and the ground was dug up and uneven. The door that the resident was let out from had a velcro sign across it reading 'caution construction.' On 8/2/19 and 8/5/19, C.N.[NAME] #1 wrote statements that she did let Resident #1 outside to the courtyard. She wrote that she asked the resident to stay in the courtyard, the resident said yes and C.N.[NAME] #1 wrote that she trusted the resident. She wrote that she checked on the resident a couple times and he/she was fine. Next she wrote that she heard a knock on the outside door on the opposite side from the courtyard. C.N.[NAME] #2 assisted Resident #1 back into the Secured Unit. Resident #1 had walked away from the courtyard and was seen by C.N.[NAME] #2 in the parking lot on the other side of the building from the courtyard. The resident was unharmed. On 8/2/19, C.N.[NAME] #2 wrote a statement confirming that she had seen the resident outside the Secured Unit in the parking lot. She went out and assisted the resident back into the building. C.N.[NAME] #2 wrote that C.N.[NAME] #1 thought it was ok to let Resident #1 out into the courtyard. On 12/17/19 at 10:00 a.m., in an interview with the Administrator, he stated that C.N.[NAME] #1 admitted to letting the resident outside into the courtyard despite the construction work. He stated that she believed the resident would not wander off. The resident was assessed and was not injured. He stated because of the safety issues, C.N.[NAME] #1's employment was terminated. On 12/17/19 at 10:45 a.m., in an interview with the Director of Nurses, he stated C.N.[NAME] #1 did let the resident out unattended by a staff member.",2020-09-01
20,MONTELLO MANOR,205006,540 COLLEGE ST,LEWISTON,ME,4240,2018-03-16,554,D,0,1,40OK11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview the facility failed to complete a Self Administration of Medication Assessment and follow their policy for a resident who self administers insulin for 1 of 13 sample residents. (Resident #17) Findings: During a review of the Resident #17's care plan, the care plan for the problem Alteration in carbohydrate metabolism indicated that Resident #17 insist on self admin insulin. Very often the staff alerts his/her of insulin remaining in pen or pooling around and out of injection site During a review of the Interdisciplinary Meeting notes (IDT) indicates the resident continues to self dose insulin with poor ability to appropriately inject insulin. The facility policy, section 500.5 Administration, indicates if resident is going to self medicate written permission from the the residents attending physician is required and a teaching plan must be developed and instituted. Resident #17 Medication Review Report signed by physician, reveals resident receives Humalog, inject per sliding scale subcutaneous with meals; Humalog 10 units subcutaneous as needed for blood sugars over 400 at bedtime; [MEDICATION NAME], inject per sliding scale subcutaneous in the morning; and [MEDICATION NAME] sliding scale subcutaneous at bedtime. During an interview, the facility provided a blank copy of their Self Administration of Medication Assessment. The medical record lacked evidence of a Self Administration of Medication Assessment was completed to determine Resident #17's cognitive, physical, and visual ability to self administer insulin. In addition, the medical record lacked evidence of a physician order [REDACTED]. On 3/15/18 at 10:35 a.m., a surveyor confirmed the finding with the Director of Nurses.",2020-09-01
21,MONTELLO MANOR,205006,540 COLLEGE ST,LEWISTON,ME,4240,2018-03-16,645,D,0,1,40OK11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record reviews, the facility failed to coordinate assessments for Pre-Admission Screening and Resident Review (PASRR) Level II program under Medicaid subpart C for 2 of 4 records with a possible serious mental disorder, intellectual disability, or a related condition as specified in PASRR Level I for Resident #11. Findings: Resident #11 was admitted to the facility on [DATE] with a mental health [DIAGNOSES REDACTED]. Resident #11's medical record indicated that a Level I screen was completed on 10/4/17 and indicated that the resident had a [DIAGNOSES REDACTED]. of a serious mental health disorder and to determine if a Level II assessment was needed. On 3/15/18 at 10:29 a.m., in an interview with the surveyor the Social Worker, he/she confirmed that there was no referral made for PASRR Level II until 3/13/18.",2020-09-01
22,MONTELLO MANOR,205006,540 COLLEGE ST,LEWISTON,ME,4240,2018-03-16,689,D,0,1,40OK11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview the facility failed to complete an assessment of residents capability and deficits to determine resident safety for 1 of 1 residents who currently smokes. (Resident #17) Findings: The facilities policy section 300.15 Smoking, indicates it does not permit smoking by resident/families/or staff on the nursing home property. During a review of Resident #17's care plan for the problem: Alteration in Cardio-pulmonary status related to [MEDICAL CONDITIONS], indicates currently smoking 1-3 x day. On the care plan evaluation section, dated 12/7/16 and 5/31/17 notes indicate continues to smoke cigarettes daily. Interdisciplinary Meeting Notes, dated 2/7/18, indicates continues to smoke cigarettes 3-4 times daily in very cold weather (off property in electric wheelchair). On 3/15/18 at approximately 3:00 p.m., a surveyor observed resident returning to facility and independently using electric wheelchair for mobility. On 3/15/18 during an interview with the resident, he/she confirmed that he/she smokes a few times during the day. Resident #17 indicated he/she has to go outside through the parking lot and up a slight hill to the area where he/she smokes. The medical record lacks evidence of resident capabilities and that the facility has taken precautions for resident individual safety.",2020-09-01
23,MONTELLO MANOR,205006,540 COLLEGE ST,LEWISTON,ME,4240,2018-03-16,761,E,0,1,40OK11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews and record review, the facility lacked evidence to support monitoring of medication refrigerator temperatures of 1 of 2 medication storage refrigerators. Finding: On [DATE] at 8:20 a.m., during an observation of the facility's medication storage refrigerator with the Nurse Manager, the refrigerator was noted to have an internal temperature reading of 39 degrees Fahrenheit. The Nurse Manager confirmed that vaccines were kept in the refrigerator for resident use. There was no observed temperature log for the medication storage refrigerator. The Nurse Manager was unable to produce a temperature log or written evidence that the refrigerator temperatures were being monitored to ensure vaccines were stored at appropriate temperatures. The Nurse Manager stated there were no temperature logs kept on the refrigerator that stored vaccines. The refrigerator contents included 9 unopened boxes of [MEDICATION NAME] vials. No observed vaccines in the refrigerator had expired. On [DATE] at 8:27 a.m., the surveyor confirmed the finding in an interview with the Nurse Manager.",2020-09-01
24,MONTELLO MANOR,205006,540 COLLEGE ST,LEWISTON,ME,4240,2019-12-18,623,B,0,1,UDD011,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record reviews and interviews, the facility failed to notify the resident and/or the resident representative in writing of the transfer/discharge to the hospital for 3 of 3 sampled residents (#30, #34, #8 ). Findings: 1. Documentation in Resident's #30's clinical record indicated Resident #30 was transferred to the hospital on [DATE] and admitted . The medical record lacked evidence that Resident #30 or his/her representative was provided a written transfer/discharge notice. On 12/17/19 at 10:30 p.m., in an interview with a Director of Nursing, a surveyor confirmed that Resident #30 or his/her representative did not receive a written transfer/discharge notice for the hospital transfer on 11/9/19. 2. Documentation in Resident's #34's clinical record indicated Resident #34 was discharged /transferred to an acute hospital on [DATE]. The clinical record lacked evidence that the facility issued a written discharge/transfer notice to include appeal rights to the resident and/or resident representative. On 12/17/19 at 11:11 a.m., in an interview with a Director of Nursing, a surveyor confirmed that Resident #34 his/her representative did not receive a written transfer/discharge notice for the hospital transfer on 12/3/19. 3. Documentation in Resident's #8's clinical record indicated Resident #8 was discharged /transferred to an acute hospital on [DATE]. The clinical record lacked evidence that the facility issued a written discharge/transfer notice to include appeal rights to the resident and/or resident representative. On 12/16/19 at 2:00 p.m. in an interview wwith the Director of Nussing, a surveyor confirmed lack of discharge/transfer notice to include appeal rights to the resident and/or resident represented.",2020-09-01
25,MONTELLO MANOR,205006,540 COLLEGE ST,LEWISTON,ME,4240,2019-12-18,625,B,0,1,UDD011,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record reviews and interviews, the facility failed to issue a written bed hold notice to a known family member or legal representative for 3 of 3 sampled residents who had been transferred to an acute care facility (Residents #30, #34, #8). Findings: 1. Documentation in Resident #30's clinical record indicated that he/she transferred to an acute care hospital on [DATE] and subsequently admitted . The clinical record contained no evidence that the facility issued a written bed hold notice to the resident, a family member, or legal representative upon transfer. On 12/17/19 at 10:30 p.m., in an interview with a Director of Nursing, a surveyor confirmed that Resident #30 or his/her representative did not receive a written bed hold policy for the hospital transfer on 11/9/19. 2. Documentation in Resident #34's clinical record indicated Resident #34 was transferred on 12/3/19 to an acute care facility for treatment of [REDACTED]. On 12/17/19 at 11:11 a.m., In an interview with the Director of Nursing, a surveyor confirmed that no bed hold notice was issued. 3. Documentation in Resident #8's clinical record indicated Resident #8's was discharged /transferred to an acute hospital on [DATE]. The clinical record lacked evidence that the facility issued a written bed hold notice to include cost of care to the resident and/or resident representative. On 12/16/19 at 2:00 p.m., in an interview with the Director of Nursing, a surveyor confirmed that lack of discharge/transfer notice to include appeal rights was given to the resident and/or resident representative.",2020-09-01
26,MONTELLO MANOR,205006,540 COLLEGE ST,LEWISTON,ME,4240,2019-12-18,641,B,0,1,UDD011,"Based on medical records review and interviews, the facility failed to ensure that a Minimum Data Set, version 3.0 (MDS) was accurately coded for 2 of 12 residents reviewed for accuracy of assessment (Resident #30 and #6). Findings: 1. Resident #30's Minimum Data Set (MDS) 3.0, dated 12/4/19, was coded to indicate that the resident received an anticoagulant during the 7 day look back period. Documentation in the medical record lacked evidence that Resident #30 received an anticoagulant during the look-back period of 11/28/19 to 12/4/19. On 12/16/19 at 2:16 p.m., during an interview with the MDS Coordinator, a surveyor confirmed the above finding. 2. Resident #6's Minimum Data Set (MDS) 3.0, dated 10/7/19, was coded to indicate that the resident received insulin. However, there was no evidence in the resident's clinical record to indicate the resident received insulin. On 12/17/19 at 1:58 p.m., during an interview with the MDS Coordinator, a surveyor confirmed that the MDS was inaccurately coded.",2020-09-01
27,MONTELLO MANOR,205006,540 COLLEGE ST,LEWISTON,ME,4240,2019-12-18,727,D,0,1,UDD011,"Based on record review and interviews, the facility failed to use the services of a Registered Nurse (RN) for at least 8 consecutive hours a day, 7 days a week on 1 of 15 days reviewed for RN coverage. Finding: During the entrance conference on 12/16/19 at 9:00 a.m., the Administrator stated they have no nurse staffing waivers. On review of the licensed staff scheduled from 12/1/19 through 12/15/19, the surveyor noted there was no Registered Nurse coverage on 12/15/19. In an interview with the surveyor on 12/16/19 at approximately 12:30 p.m., the staffing scheduler stated there was no Registered Nursing coverage on 12/15/19 and she did not inform the Director of Nursing (DON) until the next day. She stated the DON usually comes in to provide the RN coverage when there is a problem with RN coverage. In an interview with the surveyor on 12/16/19 at 1:03 p.m., the Director of Nursing (DON) stated she usually provides the RN coverage as needed but she was not informed of the shortage until the next day (12/16/19). The DON informed the surveyor there were 2 residents receiving skilled services on 12/15/19. The surveyor confirmed with the DON at this time that the facility provided no RN coverage for 8 consecutive hours on 12/15/19.",2020-09-01
28,MONTELLO MANOR,205006,540 COLLEGE ST,LEWISTON,ME,4240,2019-12-18,761,D,0,1,UDD011,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations and interviews, the facility failed to ensure an expired medication was removed from the supply available for use in 1 of 2 medication refrigerators. Finding: On [DATE] at 10:27 a.m., a surveyor observed in the North/East Medication room refrigerator, an opened multidose vial of [MEDICATION NAME], Purified Protein Derivative (TB), with an open date of [DATE]. The manufacturer's instructions indicated that once entered, vial should be discarded after 30 days. At the time of the observation the Licensed Practical Nurse confirmed the vial was available for use and 5 days past the discard date. On [DATE] at 2:35 p.m., a surveyor confirmed the above findings with the Director of Nursing.",2020-09-01
29,MONTELLO MANOR,205006,540 COLLEGE ST,LEWISTON,ME,4240,2019-12-18,880,D,0,1,UDD011,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations and interview, the facility failed to maintain an Infection Control Program designed to prevent the development and transmission of disease and infection related to hand hygiene during 1 of 4 medication administration observations. Finding: On 12/17/19 at 8:05 a.m., a surveyor observed the Licensed Practical Nurse (LPN) wash her hands prior to preparing medications for Resident #20. The LPN then moved the cart to the room door, open the Medication Administration Record [REDACTED]. After touching the above items, she then popped out a [MEDICATION NAME] 100 mg (milligrams) Extended Release capsule into her bare hand and put it in the medicine cup. At this time the surveyor intervened, the LPN confirmed she should not have touched the medication with her hands. On 12/17/19 at 8:20 a.m., a surveyor discussed and confirmed the above finding with the Director of Nursing.",2020-09-01
30,BARRON CENTER,205011,1145 BRIGHTON AVE,PORTLAND,ME,4102,2020-01-09,698,D,0,1,CTQP11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and record review the facility failed to ensure that a resident requiring [MEDICAL TREATMENT] received services consistent with the professional standards of practice and the comprehensive person-centered care plan for 1 of 2 residents sample who receive [MEDICAL TREATMENT] services (Resident #95). Finding: On review of Resident #95's clinical record, a surveyor noted the resident was receiving [MEDICAL TREATMENT] services for [MEDICAL CONDITION], stage 5. Resident #95's physician's diet order, originally dated 7/23/19 with a re-order dated 12/17/19, indicated FLUID RESTRICTION - 1600 ml (milliliters)/day. The surveyor noted on review of Resident #95's comprehensive person centered care plan, dated 10/16/19, that [MEDICAL TREATMENT] was addressed on the care plan and indicated, I need my nurses to observe me for changes in my mental status or behavior, collaborate with Southern Maine [MEDICAL TREATMENT] regarding my fluid balances, and [MEDICAL TREATMENT] treatments on M-W-F, . monitor my fluid intake as I am on a 1600 ml (milliliters)/day fluid restriction. On review of Resident #95's electronic Medication and Treatment Administration Record (MAR/TAR), the surveyor noted documentation from 12/1/19 through 1/7/20 did not reflect consistent monitoring of fluid intake. The MAR/TAR for this time period reflected 73 out of 111 shifts where fluid intake was not monitored and 37 out of 37 days where documentation did not reflect monitoring for the entire 24 hour period. In an interview with the surveyor on 1/07/20 at 12:56 PM, the charge nurse stated she looked at Resident #95's MAR/TAR and noted that the fluid intake was not being monitored according to the physician's orders [REDACTED]. In an interview with the Director and Assistant Director of Nursing on 1/7/20 at 3:15 PM, they stated Resident #95 is active throughout the facility and is noncompliant with fluid restrictions, making it very difficult for staff to monitor the resident's intake. During the interview, the surveyor confirmed the finding.",2020-09-01
31,BARRON CENTER,205011,1145 BRIGHTON AVE,PORTLAND,ME,4102,2019-07-15,609,D,1,0,HJST11,"> Based on interviews and record review, the facility failed to report immediately an alleged violation of sexual abuse to the Division of Licensing and Certification (State Survey Agency) and law enforcement officials for 1 of 1 investigated allegations of sexual abuse (Resident #1). Finding: On review of the facility's Abuse Investigation and Reporting policy and procedure, dated 11/2017 and updated 5/25/18, the surveyor noted: All alleged violations involving abuse, neglect, exploitation, or mistreatment will be reported by the facility Administrator, or his/her designee, to: . d. Law enforcement officials; and An alleged violation of abuse, neglect, exploitation or mistreatment will be reported immediately, but not later than: a. Two (2) hours if the alleged violation involves abuse . The Division of Licensing and Certification (DLC) received a facility reported incident dated stamped by fax on 7/8/19 at 12:31 p.m., in which Resident #1 alleged an employee sexually abused him/her on the evening of 7/7/19. Further review of the clinical record indicated the incident occurred prior to 1800 (6:00 p.m.) as the nurses notes indicated, Female staff assigned to perform (Resident #1's) care immediately at 1800. The surveyor could not locate evidence that the allegation was reported immediately to law enforcement and the DLC. In an interview with the Director of Nursing on 7/15/19 at 9:15 a.m., the surveyor confirmed the allegation was not reported to local law enforcement. In an interview with the Registered Nurse (RN)/Unit Manager, on 7/15/19 at 10:02 a.m., the surveyor confirmed the allegation was submitted to the DLC the next day, approximately 18 hours later. On 7/15/19 at 11:22 a.m., in an interview with the Charge Nurse/RN who was on duty the evening the allegation occurred, the surveyor confirmed he/she did not immediately report the allegation to the DLC and local law enforcement.",2020-09-01
32,BARRON CENTER,205011,1145 BRIGHTON AVE,PORTLAND,ME,4102,2017-08-30,225,D,1,0,BQJ811,"> Based on interviews and facility policy review, the facility failed to ensure all alleged violations involving misappropriation of resident property (funds) were reported timely (no later than 24 hours) to the State Survey Agency and evidence that alleged violations were thoroughly investigated for 1 of 3 residents (Resident #1). Finding: On 8/30/17 at 1:27 p.m., in an interview with Resident #1, he/she confirmed facility staff were made aware in (MONTH) of alleged missing funds in the amount of $240.00. On 8/30/17 at 11:35 a.m., in an interview with the Unit Nurse Manager, he/she acknowledged the alleged incident of Resident #1's missing funds; however, the Unit Nurse Manager could not provide evidence of a facility investigation into the missing funds, and further confirmed the allegation was not reported to the State Survey Agency. At the time of this interview, the Director of Nursing was present and he/she confirmed per regulation and their policy titled Abuse Prevention and Reporting, the facility failed to document an investigation and report the allegation to the State Survey Agency.",2020-09-01
33,BARRON CENTER,205011,1145 BRIGHTON AVE,PORTLAND,ME,4102,2017-10-26,221,D,0,1,7DKA11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interviews, the facility failed to obtain a physician's order to initiate the use of a potential restraint device for 1 sampled resident (#84) on 1 of 9 units. Finding: On 10/25/17 at 9:10 a.m., during initial tour of the Barron Center II (BC II) building, the surveyor observed Resident #84 ambulating with a Merry-Walker. On 10/25/17, in review of the resident's record, the surveyor did not find a physician order to initiate the use of the Merry Walker. On 10/25/17 at 9:35 a.m., in an interview with the BC II Nurse Manager he/she confirmed the Merry-Walker was initiated in 2014 for safe ambulation, the resident is unable to release himself/herself from the device, and confirmed a physician order was not obtained in 2014. On 10/25/17 at 12:55 p.m., in an interview with the BC II Nurse Manager he/she presented the surveyor with a Physician order for [REDACTED].",2020-09-01
34,BARRON CENTER,205011,1145 BRIGHTON AVE,PORTLAND,ME,4102,2017-10-26,329,D,0,1,7DKA11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure that 1 of 5 residents (Resident #55) sampled for unnecessary medications received a gradual dose reduction, unless clinically contraindicated, for an antipsychotic medication. Finding: On review of Resident #55's clinical record, the surveyor noted the resident's current physician's orders [REDACTED]. In an interview with the surveyor on 10/26/17 at 12:09 p.m., the Interim Administrator confirmed there is no evidence of any attempted gradual dose reductions for the antipsychotic medication [MEDICATION NAME].",2020-09-01
35,BARRON CENTER,205011,1145 BRIGHTON AVE,PORTLAND,ME,4102,2017-10-26,428,D,0,1,7DKA11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure that the licensed pharmacist identify and recommend a gradual dose reduction for an antipsychotic medication, unless clinically contraindicated, for 1 of 5 stage 2 sampled residents reviewed for unnecessary medications (#55). Finding: On review of Resident #55's clinical record, the surveyor noted the resident's current physician's orders [REDACTED]. The Pharmacist's Notes to Attending Physician/Prescriber, dated 5/2/17 and 6/2/17, did not address nor recommend a gradual dose reduction for the antipsychotic. The surveyor also reviewed the Drug Regimen Review from 5/2/17 through 10/2/17, and could not determine any recommendations made for a gradual dose reduction. In an interview with the surveyor on 10/26/17 at 12:09 p.m., the Interim Administration confirmed there is no evidence of an attempted gradual dose reduction of the antipsychotic Risperidone.",2020-09-01
36,BARRON CENTER,205011,1145 BRIGHTON AVE,PORTLAND,ME,4102,2017-10-26,514,B,0,1,7DKA11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to ensure 1 of 29 sampled stage 2 resident's (#55) clinical records was complete with regards to medication regimen reviews. Finding: On review of Resident #55's clinical record, the surveyor noted an admission date of [DATE]. When reviewing Resident #55's monthly Drug Regimen Review, the surveyor could not locate any monthly reviews completed prior to 5/2017. In an interview with the surveyor on 10/26/17 at 11:39 a.m., the 2 North Unit Clerk stated that the facility switched to a different pharmacy and when the new Pharmacist completed the initial Drug Regimen Review in May, he removed the reviews done by (the previous pharmacy) and the Unit Clerk, didn't know what he did with them. The Unit Clerk then searched the entire clinical record and could not find any Drug Regimen Reviews completed prior to (MONTH) (YEAR). The Team Leader discussed this finding with the Interim Administrator on 10/26/17 at 12:35 p.m.",2020-09-01
37,BARRON CENTER,205011,1145 BRIGHTON AVE,PORTLAND,ME,4102,2018-12-07,582,C,0,1,OYJ711,"Based on interviews and clinical record review, the facility failed to ensure liability notices, which included appeal rights, were provided to 3 of 3 residents whose Medicare services were discontinued (Residents #18, #78 and #268). Findings: 1. On review of Resident #18's liability notices, issued prior to the end of Medicare Part A services on 5/31/18, the surveyor could not locate evidence that the Notice to Medicare Provider Non-coverage (NOMNC) was provided to the resident informing his/her right to an expedited review of a service termination. 2. On review of Resident #78's liability notices, issued prior to the end of Medicare Part A services on 5/31/18, the surveyor could not locate evidence that the NOMNC was provided to the resident informing his/her right to an expedited review of a service termination. 3. On review of Resident #268's liability notices, issued prior to the end of Medicare Part A services on 10/17/18, the surveyor could not locate evidence that the NOMNC was provided to the resident informing his/her right to an expedited review of a service termination. On 12/4/18 at 2:10 p.m., in an interview with two Licensed Social Workers, the surveyor confirmed that NOMNCs were not issued prior to the end of Medicare Part A services. They stated that they verbally inform the residents of their appeal rights, however, they stated they are not providing that information in writing.",2020-09-01
38,BARRON CENTER,205011,1145 BRIGHTON AVE,PORTLAND,ME,4102,2018-12-07,625,B,0,1,OYJ711,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interviews, the facility failed to issue bed hold notices to the resident's representative for 2 of 5 sampled residents who had been transferred to an acute care facility (#137 and 167). Finding: 1. Documentation in Resident #137's clinical record indicated that he/she was transferred to an acute hospital on [DATE] and subsequently admitted . The clinical record lacked evidence that the facility issued a bed hold notice to the resident's representative. On 12/4/18 at 1:29 p.m., during an interview with a surveyor, the Social Worker stated that she was unable to find evidence that the written transfer/discharge notice was given to Resident Representative #137. 2. Review of the documentation in the clinical record indicated that Resident #167 was transferred to an acute care facility and subsequently admitted on [DATE]. The clinical record lacked evidence that the facility issued a bed hold notice to the resident's representative. In an interview with the surveyor on 12/4/18 at 1:25 p.m., the Licensed Social Worker (LSW) provided a copy of the Notice of Transfer/Discharge form for Resident #167 provided to the resident's representative on 11/19/18. The written transfer form lacked evidence of bed hold policy and rate information provided to the representative. The LSW acknowledged the finding and confirmed the rate was not added to the form in error. In an interview with surveyor on 12/4/18, at 8:00 a.m., Resident #167 indicated he/she was made aware of the reason for the transfer but had received no written information on the facility's policy on bed hold. In an interview with the surveyor and the Director of Nursing Services on 12/7/18, at 8:15 a. m., the finding on Resident #167 was discussed. The surveyor confirmed the finding during the interview.",2020-09-01
39,BARRON CENTER,205011,1145 BRIGHTON AVE,PORTLAND,ME,4102,2018-12-07,641,C,0,1,OYJ711,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on electronic medical records review and interviews, the facility failed to ensure that a Minimum Data Set, version 3.0 (MDS)was accurately coded for restraints in 3 of 4 residents reviewed for restraints (Residents #70, #76 & #140). Findings: 1. Review of Resident #70's electronic charting revealed completion of a Side Rail/Restraint assessment dated [DATE] which noted Resident uses 1/4 rails for mobility assist, not considered a restraint. Resident #70's quarterly MDS assessment dated [DATE], was inaccurately coded in Section P: Restraints to reflect the use of a restraint. 2. Observation of Resident #76's bed noted bilateral 1/4 rails. In an interview with the Nurse Manager, the Surveyor confirmed that the 1/4 rails are not a restraint. Resident #76's quarterly MDS assessment dated [DATE], was inaccurately coded in Section P: Restraints to reflect the use of a restraint. 3. Review of Resident #240's electronic charting reveals completion of a Side Rail/Restraint assessment dated [DATE] which notes Resident uses 1/4 rails for mobility assist, not considered a restraint. Resident #140's annual MDS assessment dated [DATE], was inaccurately coded in Section P: Restraints to reflect the use of a restraint. On 12/6/18 between 9:00 a.m. and 9:30 a.m., the two MDS Coordinators, in an interview with the two Surveyors stated that there are no residents in house with a restraint nor are there residents who cannot get out of bed around their side rail. The Surveyors confirmed the findings at the time of the interview.",2020-09-01
40,BARRON CENTER,205011,1145 BRIGHTON AVE,PORTLAND,ME,4102,2018-12-07,656,D,0,1,OYJ711,"Based on interviews and record review, the facility failed to develop a care plan to meet the safety needs of 1 of 1 residents reviewed for smoking (Resident #45). Finding: On 12/3/18 at 12:29 p.m., Resident #45 stated to the surveyor he was heading out to smoke. He stated he kept his own cigarettes and lighter with him at all times. On 12/4/18 at 7:18 a.m., the surveyor observed Resident #45 smoking in a designated smoking area with appropriate safety measures in place. A review of the Facility's Smoking Policy - Residents, dated (MONTH) (YEAR), indicated: 6. The resident will be evaluated on admission to determine if her or she is a smoker or non-smoker. If a smoker, the evaluation will include: a. Current level of tobacco consumption; b. Method of tobacco consumption (traditional cigarettes; electronic cigarettes; pipe, etc.); c. Desire to quit smoking, if a current smoker; and d. Ability to smoke safely without supervision. On review of Resident #45's comprehensive care plan, initiated 6/27/18 and revised 9/21/18, the surveyor could not find evidence that the care plan included an evaluation and monitoring of safe smoking practices. In an interview with the Registered Nurse, Unit Manager on 12/4/18 at approx 2:00 p.m., the surveyor confirmed that the clinical record did not have a completed evaluation on Resident #45 to determine the Resident's ability to smoke safely without supervision and the care plan did not include safe smoking practices.",2020-09-01
41,BARRON CENTER,205011,1145 BRIGHTON AVE,PORTLAND,ME,4102,2018-12-07,661,D,0,1,OYJ711,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and clinical record review, the facility failed to develop a discharge summary which included a recapitulation of the resident's stay, a final summary of the resident's status, and reconciliation of all the resident's pre- and post-discharge medications for 1 of 1 resident reviewed for discharge to the community (Resident #169). Finding: On review of Resident #169's clinical record, a surveyor noted an admission date of [DATE] for respite care. The resident received hospice services prior to and throughout his/her admission. Resident #169 discharge back to the community with continued hospice services on 9/6/18. The surveyor could find no evidence in Resident #169's clinical record of a recapitulation of the Resident's stay, a final summary of his/her status or a summary of the Resident's pre- and post-discharge medications in the hard or electronic clinical record. During an Interview with the Director of Nursing Services, the Nursing Special Projects Registered Nurse and the Assistant Director of Nursing on 12/6/18 at 3:30 p.m., they stated a recap of the Resident's stay was not completed as the Resident remained on hospice services throughout his/her admission and returned to the community with the same hospice agency providing care in the community. At this time, the surveyor confirmed the medical record did not contain a recapitulation of Resident #169's stay in the facility.",2020-09-01
42,BARRON CENTER,205011,1145 BRIGHTON AVE,PORTLAND,ME,4102,2018-12-07,692,E,0,1,OYJ711,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interviews and record review, the facility failed to provide recommended nutritional services to 1 of 1 residents (#103) reviewed with a gastrostomy tube (tube feeding) for 15 days. Finding: During an initial observation of Resident #103 on 12/3/18 at 9:30 a.m., and again on 12/4/18 at 3:41 p.m., the resident appeared well nourished and hydrated. On review of Resident #103's clinical record, the surveyor noted physician's orders [REDACTED]., dated 9/12/18 for [MEDICATION NAME] 1.2cal with water auto-flush 110ml/hour continuous for 10 hours, on at 10:00 p.m., off at 6:00 a.m. The surveyor also noted a Registered Dietitian's (RD) electronic note, dated 11/21/18, which indicated: Weights are trending down as follows (11/3) 128#(pounds); (11/11) 122#. Trend indicates a loss of 6#, 4.7% within the month, almost qualifying as significant weight loss. Care must be taken to halt further weight loss. PLAN: 1. increase weight monitoring frequency to 3 times weekly for closer monitoring. 2. Extend length of tube feeding period by 2 hours if next weight is below 122# 3. Monitor skin integrity. On further review of the clinical record, the surveyor noted no additional weights recorded in Resident #103's clinical record except one weight of 127.8#, dated 11/24/18. The surveyor interviewed the Dietary Director on 12/6/18 at 7:31 a.m., who stated the dietary department did not make the physician and nursing staff of the RD's recommendations. The Dietary Director then showed the surveyor the Nutritional [DIAGNOSES REDACTED]. The form did not indicate the physician's approval of the recommendations. The surveyor confirmed with the Dietary Director at this time that the RD's recommendations were not followed from 11/21/18 to 12/6/18.",2020-09-01
43,BARRON CENTER,205011,1145 BRIGHTON AVE,PORTLAND,ME,4102,2018-12-07,812,D,0,1,OYJ711,"Based on observation and interview, the facility failed to ensure two containers of applesauce were dated when opened and not in use beyond discard dates as indicated per manufacture specifications; and failed to ensure that containers were removed from the refrigerator and unavailable for resident use, in 1 of 3 refrigerators (Deering Unit) on 2 of 4 days of survey. Findings: On 12/3/18 at 12:01 p.m., during a check of (3) refrigerators located in the BC2 building, it was noted in the Deering Unit kitchen refrigerator that two applesauce containers, one dated 9/13/18 and the second dated 10/4/18 were opened and in use. On 12/4/18 at 7:28 a.m., the Food Service Director stated the dates on the containers of applesauce are the dates they were received not opened. The surveyor located the discard dates as indicated per instructions on the labels of applesauce, Refrigerate immediately once opened and use within 10 days. The surveyor confirmed with the Food Service Director that there was no open date to determine how long the applesauce jars had been opened.",2020-09-01
44,BARRON CENTER,205011,1145 BRIGHTON AVE,PORTLAND,ME,4102,2018-12-07,880,E,0,1,OYJ711,"Based on observations and interviews, the facility failed to maintain an infection control program designed to help prevent the development and transmission of infection related to pressure ulcer treatment for 1 of 3 sampled residents with pressure ulcers (Resident #36) and ensure that a urinary drainage bag and tubing was secured off the floor for 1 of 3 residents reviewed with an indwelling urinary catheter (Resident #26) during 1 of 4 survey days. Findings: 1. On 12/4/18 at 8:00 a.m., a surveyor observed with the charge nurse that Resident #26's Foley catheter bag was hanging underneath his/her wheelchair with the bag touching the floor and the urinary catheter tubing lying on and dragging on the floor with movement. The charge nurse acknowledged the finding and the infection control concern. In an interview with the surveyor and the nursing staff on 12/6/18, at 9:16 a.m., the finding was discussed with the nurse confirming that re-education of the nursing staff on positioning of Foley catheter bags and tubing was completed on 12/5/18. In an interview with the surveyor and the Director of Nursing Services (DNS) on 12/7/18, at 8:15 a. m., the finding was discussed. The surveyor confirmed the finding during the interview 2. On 12/6/18 at 10:39 a.m., 2 surveyors observed a Registered Nurse (RN) provide treatment to Resident #36's pressure ulcer. At the onset of the treatment, the RN washed his/her hands and donned clean gloves, then removed the soiled dressing, cleansed the wound with normal saline, opened up the sterile treated dressing package and removed the sterile treated dressing with the same gloved hands. The surveyor halted the procedure and directed the RN to change gloves. The RN proceeded with the treatment with clean gloves and a new sterile treated dressing. In an interview with the RN and RN Unit Manager directly following the procedure, the surveyor confirmed that the gloves were no longer clean once they were used to remove a soiled dressing and clean a wound.",2020-09-01
45,NEWTON CENTER,205012,35 JULY STREET,SANFORD,ME,4073,2017-09-25,225,B,1,0,3PYW11,"> Based on interviews and facility policy review, the facility failed to ensure an alleged violation of abuse was reported immediately, to the administrator and to the State Survey Agency (Department of Health and Human Services, DHHS, Division of Licensing and Certification, for 1of 2 residents reviewed. (#1) Finding: On 9/11/17, a Nursing Facility Reportable Incident Form was received from The[NAME]Center via fax in the Division of Licensing and Certification offices which indicated an allegation of abuse of a resident (Resident #1) by a Certified Nursing Assistant (CNA) with an occurance incident date of 9/9/17, a Saturday. Interviews and record review indicated no evidence that the allegation was reported to the DHHS State Offices until the following Monday. Review of the facility's Preventing Abuse policy states that it is the policy of[NAME]Center to not condone any form of resident abuse and to continually monitor facility policies, practices, and training/education programs to assist in preventing abuse. The reporting directions of this policy are included under the Reporting Suspicion of Abuse, section # 2 which states the DON or designee will report the incident immediately (defined as within 24 hours): Division of Licensing and Certification by calling #1-800-383-2441 as soon as possible but in a timeframe not to exceed 24 hours of knowledge of the incident. In an interview on 9/25/17 at 2:00 p.m., the finding for late reporting was discussed with the Administrator and Director of Nursing. The Administrator confirmed the report was sent to the state offices after the CNA reported to administration on 9/11/17. The administrator further indicated the reporting CNA was re-educated on the reporting requirements to the state offices.",2020-09-01
46,NEWTON CENTER,205012,35 JULY STREET,SANFORD,ME,4073,2018-12-03,760,D,1,0,TVEZ11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on closed record review and interviews, the facility failed to ensure 1 of 3 residents sampled residents was free of a significant medication error (#1). Finding: Review of Resident #1's closed medical record reveals a physician telephone order dated 11/21/18 indicating [MEDICATION NAME] 1 mg (milligram) po (oral) SL (sublingual) q (every) 2 hours prn (as necessary) and [MEDICATION NAME] 1 mg po SL q 6 hours. D/C (discontinue) [MEDICATION NAME] tablets. The medication [MEDICATION NAME] is in the form of a liquid and the dosage is as follows: 2 mg in 1 milliliter (ml), requiring that Resident #1 be administered 0.5 milliliters to equal 1 mg. Review of a facility incident report indicates that on 11/21/18 Resident #1 received 5 milliliters of the medication [MEDICATION NAME] to equal 10 milligrams in error at 14:30 (2:30 p.m.), a review of Resident #1's Medication Administration Record [REDACTED]. Review of nurses' notes dated 11/29/18 indicates late entry for 11-21-18 at 1640 (4:40 p.m.) Pt (patient) was given a larger then ordered dose of [MEDICATION NAME] @ (at) 1430 . On 12/3/18 at approximately 11:30 a.m. in an interview with a Certified Nursing Assistant/Medications (CNA/M) he/she confirms that on 11/21/18 at 14:30 5 ml's of [MEDICATION NAME] was administered to Resident #1 in error, explaining that a different syringe was used to administer the [MEDICATION NAME], the syringe was not the syringe/dropper that was provided with the medication from the manufacturer. On 12/3/18 at approximately 1:30 p.m. in an interview with the Director of Nursing he/she indicates that it is the facility policy that two staff persons (licensed staff or CNA/M's) verify the correct dose of all liquid controlled substances prior to administration, and further indicated that this was done for Resident #1 on 11/21/18 at 14:30; however, both CNA/M's incorrectly verified the dose of 5 ml's as correct, resulting in Resident #1 receiving 10 mg of [MEDICATION NAME] instead of the ordered dose of 1 mg. On 12/3/18 at approximately 2:30 p.m. the surveyor confirmed the finding in an interview with the Director of Nursing.",2020-09-01
47,NEWTON CENTER,205012,35 JULY STREET,SANFORD,ME,4073,2019-12-11,758,D,0,1,T3B011,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record reviews and interviews the facility failed to ensure as needed (PRN) [MEDICAL CONDITION] medications met the required 14-day limit for 1 of 6 residents reviewed for unnecessary medications (Resident #5). Finding: A review of physician's orders [REDACTED]. On review of the resident's current physician's orders [REDACTED]. The medical record lacked evidence the medication order was stopped and there was no evidence the physician reviewed the order to provide rational to continue the (PRN) medication. On 12/10/19 at 2:51 PM in an interview with the Director of Nursing, the surveyor confirmed Resident #5 was prescribed a PRN antipsychotic since 10/8/19 with no stop date after 14 days and no re-evaluation of the order.",2020-09-01
48,NEWTON CENTER,205012,35 JULY STREET,SANFORD,ME,4073,2019-12-11,883,E,0,1,T3B011,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record reviews and interviews the facility failed to ensure that 3 of 5 residents reviewed for immunizations received pneumococcal vaccinations (Residents #20, #38 and #41). Findings: 1. During a review of Resident #20's immunization record, the surveyor noted the Resident received the Pneumococcal Conjugate Vaccine (Prevnar 13) on 5/15/18. The surveyor could not locate evidence that the second vaccine, Pneumococcal [MEDICATION NAME] Vaccine (PPSV23), was provided to the resident. In an interview with the Infection Preventionist on 12/10/19 at 11:45 PM, the surveyor confirmed that Resident #20 did not receive the PPSV23. 2. During a review of Resident #38's immunization record, the surveyor noted the resident received the PPSV23 on 10/1/07. The surveyor could not locate evidence that the second vaccine, Prevnar 13, was provided to the resident. In an interview with the Infection Preventionist, on 12/10/19 at 11:45 PM, the surveyor confirmed that Resident #38 did not receive the second pneumococcal vaccination. 3. During a review of Resident #41's immunization record, the surveyor noted the resident received the PPSV23 on 5/18/15, but could not locate evidence that the second vaccine, Prevnar 13, was provided to the resident. In an interview with the Infection Preventionist on 12/10/19 at 11:45 PM, the surveyor confirmed that Resident #41 did not receive the Prevnar 13 vaccination.",2020-09-01
49,NEWTON CENTER,205012,35 JULY STREET,SANFORD,ME,4073,2018-12-13,641,B,0,1,IWWA11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on medical records review and interviews, the facility failed to ensure that a Minimum Data Set, version 3.0 (MDS) was accurately coded for 3 of 37 residents reviewed for accuracy of assessment (#44, #47 & #61). Findings: 1. Review of Resident #44's MDS, dated [DATE], was coded, in Section A1500, to indicate that the resident did not have a Level II Preadmission Screening and Resident Review (PASRR), by coding no to the question Has the resident been evaluated by Level II PASRR and determined to have a serious mental illness and/or mental [MEDICAL CONDITION] or a related condidtion? Documentation in the medical record revealed that a Level II PASRR was completed on 1/19/18. On 12/13/18, between 9:00 a.m. and 9:30 a.m., in an interview with two MDS Coordinators, a surveyor confirmed that Section A1500 was miscoded for Level II Preadmission Screening and Resident Review. 2. Review of Resident #47's MDS, dated [DATE], was coded, in Section N0400E, to indicate that the resident received an anticoagulant during the 7 day look back period. Documentation in the medical record revealed that the resident did not have a physicia'ns order for an anticoagulant. On 12/13/18, in an interview with two MDS Coordinators, a surveyor confirmed that Section N0400E was miscoded for use of anticoagulant. 3. Resident #61's MDS, dated [DATE], was coded, in Section N: Medications, N0400A to indicate that the resident received an antipsychotic during the 7 day look back period. A medical record review revealed that the resident did not have an order for [REDACTED].>On 12/12/18 at 9:36 a.m. in an interview with the MDS Coordinator, a surveyor confirmed the coding error for Section N0400[NAME]",2020-09-01
50,NEWTON CENTER,205012,35 JULY STREET,SANFORD,ME,4073,2018-12-13,646,D,0,1,IWWA11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record reviews and interview, the facility failed to send a new Preadmission Screening and Resident Review (PASRR) Level I Screen due to a status change, indicating a change in condition, which must be submitted to KEPRO for review for 1 of 2 sampled residents with a mental disorder (#19). Findings: Instructions on the PASARR Level I Screen, Terminal Illness Waiver, states, Should the individual's status change, a new Level I Screen indicating a change in condition must be submitted to KEPRO for review. During review of Resident # 19's clinical record, the surveyor noted that Resident #19 has a [DIAGNOSES REDACTED]. The Level I PASARR dated 4/18/18 had a Terminal Illness Waiver which states, Should the individual's status change a new Level I Screen indicating a change in condition must be submitted to KEPRO for review. On 9/26/18 the Hospice Agency issued a discharge revocation of services. On 12/12/18 at 03:15PM in an interview with the Social Worker, the Surveyor confirmed with the Social Worker that currently there is no evidence that a new PASARR Level I was completed following the change in condition per Terminal illness Waiver instructions.",2020-09-01
51,NEWTON CENTER,205012,35 JULY STREET,SANFORD,ME,4073,2018-12-13,656,E,0,1,IWWA11,"Based on interviews and records review, the facility failed to develop a care plan to meet the safety needs of 2 of 2 residents reviewed for smoking (Resident #15 and #47). Findings: 1. On 12/11/18 at 10:23 a.m., during an interview with Resident #15, the surveyor determined the resident smokes cigarettes independently off the facility campus. On 12/12/18 at 9:53 a.m., the surveyor accompanied Resident #15 off campus and continued with the interview. The resident pointed to area that is off-limits to him as he flipped his wheel chair in the past. On review of Resident #15's clinical record, a surveyor noted a smoking reassessment, dated 12/8/18. The reassessment indicated, Yes to the question Plan of care is used to assure resident is safe while smoking? On review of the care plan, written 2/7/18 and most recently reviewed 10/11/18, the surveyor could find no care plan developed to address the smoking safety needs of Resident #15. On 12/12/18 at 11:17 a.m., the surveyor confirmed in an interview with the Director of Nursing that Resident #15's plan of care was not developed to address Resident #15's safety while smoking. 2. On 12/12/18 at 11:45 a.m., during an interview with Resident #47, the Surveyor determined that he/she smokes independently off the facility campus. On review of Resident #47's clinical record, the Surveyor noted a smoking assessment, dated 11/4/18. The assessment indicated, Yes to the question Plan of care is used to assure resident is safe while smoking? On 12/13/18 at 1:10 p.m., the surveyor confirmed in an interview with the Director of Nursing that a plan of care was not developed to address Resident #47's safety while smoking.",2020-09-01
52,NEWTON CENTER,205012,35 JULY STREET,SANFORD,ME,4073,2018-12-13,661,D,0,1,IWWA11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review, the facility failed to develop a discharge summary that included a recapitulation of the resident's stay for 1 of 1 residents reviewed for a community discharge (Resident #66). Finding: On review of Resident #66's clinical record, a surveyor noted an admission date of [DATE] with a discharge back to the community on 9/17/18. The surveyor noted in the clinical record a Recapitulation of Resident Stay form in which the following sections were left blank: Nursing, Status on Discharge, Dietary and Activity Department. Social Services staff completed their component of the form. The surveyor reviewed the nursing notes and noted no summary of Resident #66's care and status while in the facility. During an interview with the Director of Nursing on 12/13/18 at approximately 11:00 a.m., the surveyor confirmed the medical record did not contain a complete recapitulation of Resident #66's stay in the facility.",2020-09-01
53,NEWTON CENTER,205012,35 JULY STREET,SANFORD,ME,4073,2018-12-13,688,E,0,1,IWWA11,"Based on interviews and record review, the facility failed to provide services to maintain and/or improve residents' highest level of range of motion (ROM) and/or mobility for 2 of 2 residents reviewed for limited range of motion (Resident #15 and #26). Findings: 1. On 12/11/18 at 10:33 a.m., in an interview with the surveyor, Resident #15 stated, they don't do any exercises of range of motion. On review of Resident #15's care plan, dated 2/7/18 with the most recent review of the care plan dated 10/11/8, the surveyor noted the resident has limited physical mobility with the approach to provide gentle range of motion as tolerated with daily care. On further review of Resident #15's clinical record, the surveyor noted documentation sheets, indicating PROM with instructions to initial and document the amount of time spent on the exercises. The documentation for (MONTH) (YEAR) indicated the resident received PROM a total of five out of 60 shifts and from 12/1/8 through 12/12/18, the documentation indicated Resident #15 did not receive and PROM services. In an interview with Minimum Data Set Coordinators (MDS-C), Registered Nurses (RN) on 12/12/18 at 12:31 p.m., They stated that the PROM is done by the assigned Certified Nursing Assistants (CNA) with caregiving. On 12/12/18 at 1:42 p.m., a CNA stated in an interview with the surveyor that he/she does not perform PROM when giving care unless assigned to be the restorative aide for the shift. In a follow-up interview with the MDS-C on 12/12/18 at 2:30 p.m. the surveyor confirmed that PROM services are not being provided as care planned. 2. On 12/11/18 at 10:09 a.m., during an interview with the surveyor, Resident #26 stated that staff do not routinely exercise me. On review of Resident #26's clinical record, a surveyor noted a restorative program, dated 7/1/18, to: > maintain or improve (Resident #26's) ability to ambulate 15 to 100 feet with 2 staff assist for a minimum of 15 minutes daily, 6-7 days a week; > maintain or improve (Resident #26's) functional transfer ability with 1 staff assist for a minimum to moderate assist for a minimum of 15 minutes daily, 6-7 days a week; and > (Resident #26) will maintain or improve Assisted Active Range of Motion (AAROM) to right upper extremity for a minimum of 15 minutes daily, 6-7 days a week. A review of the clinical documentation in (MONTH) (YEAR), the resident received or was offered restorative ambulation services 8 times; in (MONTH) (YEAR) - 12 times; and through 12/1/18 - 12/12/2018 - 2 times. A review of clinical documentation in (MONTH) (YEAR), the resident received or was offered restorative transfer services 11 times; in (MONTH) (YEAR) - 8 times; and through 12/1/18 - 12/12/2018 - 8 times. A review of clinical documentation in (MONTH) (YEAR), the resident received or was offered restorative range of motion services 8 times; in (MONTH) (YEAR) - 12 times and through (MONTH) 12, (YEAR) - none. A Rehab Screen Form, dated 8/10/18, indicated no change in the Resident's status. On 12/12/18 at 1:42 p.m., a CNA stated in an interview with the surveyor that he/she does not perform restorative services when giving care unless assigned to be the restorative aide for the shift. In a follow-up interview with the MDS-C on 12/12/18 at 2:30 p.m. the surveyor confirmed that restorative services are not being provided as care planned.",2020-09-01
54,NEWTON CENTER,205012,35 JULY STREET,SANFORD,ME,4073,2018-12-13,698,D,0,1,IWWA11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the facility failed to ensure that a resident requiring [MEDICAL TREATMENT] receive services consistent with the professional standards of practice for 1 of 1 resident receiving [MEDICAL TREATMENT] services (#41). Finding: On review of Resident #41, a surveyor noted the resident was admitted to the facility on [DATE] with a [DIAGNOSES REDACTED]. Resident #41 had a physician's orders [REDACTED]. Also included in Resident #41's clinical record was the Care of the A-V Fistula or Graft that indicated, Check the access for the presence of a bruit and/or thrill several times a day. If the bruit or thrill is not detectable, notify the [MEDICAL TREATMENT] unit and nephrologist immediately. On review of Resident #41's Treatment Administration Record, the surveyor noted documentation supporting monitoring of the A-V fistula does not reflect consistent provision of care. The (MONTH) (YEAR) Treatment Administration Record reflected 12 out of 93 shifts where provision of A-V fistula monitoring for thrill and bruit was not documented; The (MONTH) (YEAR) Treatment Administration Record reflected 18 out 90 shifts where provision of A-V fistula monitoring for thrill and bruit was not documented; and (MONTH) 1 through 11, (YEAR) Treatment Administration Record reflected 6 out 33 shifts where provision of A-V fistula monitoring for thrill and bruit was not documented. In an interview with the Registered Nurse - Nurse Coordinator on 12/13/18 at 5:54 a.m., the surveyor confirmed that documentation does not reflect Resident #41's A-V Fistula site was checked for thrill, bruit and site maintenance each shift.",2020-09-01
55,NEWTON CENTER,205012,35 JULY STREET,SANFORD,ME,4073,2018-12-13,812,D,0,1,IWWA11,"Based on observations and interview, the facility failed to serve food in a sanitary manner on 1 of 3 survey days. Finding: On 12/13/18 at 9:04 a.m., two Certified Nursing Assistants (CNA) entered the 100 Unit kitchenette. CNA #1 removed bread from a bread bag with ungloved hands and placed the bread in a toaster. CNA #2 also removed bread from the bread bag with ungloved hands and awaited use of the toaster. With ungloved hands, CNA #1 removed the toast from the toaster and placed it on a plate. The surveyor intervened and discussed the practice of handling ready to eat foods with bare hands. The CNAs then obtained gloves to handle ready to eat foods. At 12/13/18 on 11:00 a.m. in an interview with the Manager of Food Services and Chef, the surveyor confirmed that staff cannot handle ready to eat foods with bare hands.",2020-09-01
56,NEWTON CENTER,205012,35 JULY STREET,SANFORD,ME,4073,2017-12-15,584,E,0,1,NQNW11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations and interviews, the facility failed to maintain a safe, clean, comfortable and homelike environment on 2 of 3 units. Finding: During tour of the facility with the Surveyor on 12/13/17 at 9:45 a.m., the Environmental Services Supervisor and Eldercare Maintenance Mechanic observed and confirmed the following findings: -The 100 unit tub room contained 3 unsecured cleaning chemicals: 1 container of Super Sani-Cloth Germicidal Wipes and 1 container of Sani-Hand Sanitizer Wipes on an open shelf, and 1 container of Cen-Kleen IV in an unlocked cabinet, thus creating an unsafe environment. -Resident room [ROOM NUMBER] had a crack in the bathroom door casing that was approximately 2 inches long. -Resident room [ROOM NUMBER] had a cracked ceiling tile in the bathroom around the light and vent unit, and the bathroom door casing had a crack approximately 5 inches long. -Resident room [ROOM NUMBER] had a cracked ceiling tile in the bathroom around the light and vent unit. -The 300 unit Bath room contained 2 unsecured chemical cleaners in an unlocked room in an unlocked cabinet: 1 bottle of HyperFect Disinfectant Cleaner and 1 bottle of Cor Product Pearl Creme, thus creating an unsafe environment. -Resident room [ROOM NUMBER] had a crack, approximately 1 centimeter, between the window sill and window and the room temperature was 64.2 degrees Fahrenheit (required range 71 to 81 degrees Fahrenheit) by the window, thus creating an uncomfortable environment. room [ROOM NUMBER] also had a cable cord that was partially affixed to the wall and approximately 2.5 feet of cord that had come apart from the wall. -Resident room [ROOM NUMBER] had an electric wheel chair with caked on food debris and crumbs at the food base, a recliner chair that had food debris stains, and a bathroom door casing with a crack of approximately 4 inches. -Resident room [ROOM NUMBER] had space between the window and sill that created a draft and the room temperature by the window was 65.4 degrees Fahrenheit (required range 71 to 81 degrees Fahrenheit), thus creating an uncomfortable environment. -Resident room [ROOM NUMBER] with a bathroom door casing that was cracked. On 12/13/17, during the environmental tour, the Environmental Services Supervisor and Eldercare Maintenance Mechanic removed the unsecured chemical cleaners. On 12/13/17 at 3:45 p.m., in an interview with the Administrator, he/she was made aware of the above findings.",2020-09-01
57,NEWTON CENTER,205012,35 JULY STREET,SANFORD,ME,4073,2017-12-15,657,D,0,1,NQNW11,"Based on observations, interviews and record review, the facility failed to revise the care plan by an interdisciplinary team who have knowledge of the resident's needs for 2 of 14 residents whose care plans were reviewed. (#27, #11) Findings: 1. On 12/11/17 at 10:44 a.m., the surveyor noted Resident #27 in his/her room very loudly and repetitively stating, I want to go to bed; I can't help it; I want to go home; I want to buy hay; and I can't find hay. Also noted was another resident loudly calling out, shut up! No further repetitive statements noted during the remainder of the survey. During an interview with the surveyor on 12/12/17 at 1:00 p.m., Certified Nursing Assistant (CNA) #1 stated that Resident #27, doesn't really understand what is going on; when (resident) is yelling out, (he/she) may be yelling out something he/she wants but it may be something totally unrelated. Lollipops calm (him/her) down, so I always keep them handy. CNA #1 further added that when Resident #27 is yelling out, he/she usually is calmed if given a sucker. In an interview with the surveyor on 12/12/17 at 1:22 p.m., CNA #2 stated that Resident #27 talks loudly and he/she will yell out vulgarities at times. In an interview with the surveyor on 12/13/17 at 9:00 a.m., a Licensed Practical Nurse (LPN) stated that Resident #27 talks really loudly and also confirmed that suckers calm (the resident) at times. The LPN confirmed in a later interview at 11:28 a.m. that when the Resident talks loudly, it does disturb another resident on the unit who yells, Shut up. On 12/13/17 at 9:09 a.m., in an interview with the surveyor, the Care Coordinator stated that Resident #27 just talks loudly and also stated that if CNAs are providing the Resident lollipops, we really don't know about it. In a follow-up interview with the surveyor on 12/13/17 at 12:23 p.m., the Care Coordinator confirmed the care plan does not address the loud and vulgar talking. She stated the team does not believe it is a behavior but then confirmed it does bother other residents. The Care Coordinator also confirmed that other approaches such as 1:1 and lying the resident down for a nap are utilized when Resident #27 is loudly making sexual comments or repetitive verbalizations. The Care Coordinator then confirmed that these behaviors and approaches are not on the care plan. On 12/13/17 at 1:13 p.m., in an interview with the surveyor, both Minimum Data Set (MDS) coordinators, confirmed that the MDS did accurately assess that there were no behaviors at the time of the assessment, but they also confirmed that care plan did not address behaviors and confirmed that the CNAs are not invited to attend the care plan meetings but they are working on that. 2. On 12/14/17 at 11:15 a.m., Resident #11's care plan lacked evidence that the care plan was revised to reflect a change in skin condition when Resident #11 acquired a diabetic ulcer, noted in a physician's note dated 8/8/17. On 12/14/17 at 12:15 p.m., in an interview with a surveyor, the MDS Coordinator confirmed that the care plan was not revised to reflect a change in skin condition.",2020-09-01
58,NEWTON CENTER,205012,35 JULY STREET,SANFORD,ME,4073,2017-12-15,689,E,0,1,NQNW11,"Based on observations and interviews, the facility failed to maintain a resident environment as free of accident hazards as is possible on 2 of 3 units. Findings: During tour of the facility with the Surveyor on 12/13/17 at 9:45 a.m., the Environmental Services Supervisor and Eldercare Maintenance Mechanic observed and confirmed the following findings: -The 100 unit tub room contained 3 unsecured cleaning chemicals: 1 container of Super Sani-Cloth Germicidal Wipes and 1 container of Sani-Hand Sanitizer Wipes were observed on an open shelf, and 1 container of Cen-Kleen IV in an unlocked cabinet. -The 300 unit Bath room contained 2 unsecured chemical cleaners in an unlocked room in an unlocked cabinet: 1 bottle of HyperFect Disinfectant Cleaner and 1 bottle of Cor Product[NAME]Creme. Safety Data Sheet Information: -According to the Super Sani-Cloth Germicidal Wipe Safety Data Sheet: Hazard Statements: causes serious eye irritation -According to the Sani-Hands Instant Hand Sanitizing Wipes Safety Data Sheet: Hazard Statement: Causes serious eye irritation -According to the Cen-Kleen IV Safety Data Sheet: Hazard Statements: Causes serious eye irritation, causes skin irritation -According to the Hyperfect 256 Safety Data Sheet: Health Hazards: Causes skin irritation, causes severe eye damage -According to the Cor Products[NAME]Creme Safety Data Sheet: Hazard Statements: Harmful if swallowed. Causes skin irritation. Causes serious eye damage. On 12/13/17, during the environmental tour, the Environmental Services Supervisor and Eldercare Maintenance Mechanic removed the unsecured chemical cleaners. On 12/13/17 at 3:45 p.m., in an interview with the Administrator, he/she was made aware of the above findings.",2020-09-01
59,AROOSTOOK HEALTH CENTER,205018,PO BOX 410,MARS HILL,ME,4758,2017-06-14,309,D,0,1,OWZD11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to follow a physician order [REDACTED]. Finding: Resident #115's physician orders [REDACTED]. There were no additional physician orders [REDACTED]. On 6/12/17, at 12:00 p.m., Resident #115's electronic Medication Administration Record [REDACTED]. Resident #115 received doses of [MEDICATION NAME] on Saturday, 6/3/17 at 9:14 a.m. and 12:51 p.m., because Resident #115 was complaining of anxiety, on Sunday, (MONTH) 4 at 11:17 a.m., for anxiety after getting out of bed, and on Thursday, (MONTH) 8 at 3:39 p.m. with no reason given documented. In addition, the nurse's progress notes, dated Wednesday 6/7/17 at 10:50 a.m., indicated Resident #115 received a wound vac change, however; the EMAR lacked evidence that [MEDICATION NAME] 0.5 mg by mouth was administered 30 minutes prior to the wound vac change as directed by the physician order. On 6/12/17 at 2:45 p.m., during an interview with a surveyor, Registered Nurse (RN) #1 confirmed that the [MEDICATION NAME] was not always administered as the physician order [REDACTED].",2020-09-01
60,AROOSTOOK HEALTH CENTER,205018,PO BOX 410,MARS HILL,ME,4758,2017-06-14,315,E,0,1,OWZD11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record reviews and interviews, the facility failed to ensure that a physician order [REDACTED].#115). In addition, the facility failed to ensure a physician order [REDACTED].#78). Findings: 1. On 6/12/17 at 11:17 a.m., during an interview with a surveyor, Registered Nurse (RN) #1 stated that Resident #115 was admitted to the facility with a foley catheter in place due to a pressure ulcer. On 6/12/17 at 1:40 p.m , a surveyor observed Resident #115 and noted a foley catheter bag covered, attached to the resident's bed. On 6/12/17 at 2:00 p.m., Resident #115's clinical record was reviewed. Resident #115's clinical record lacked evidence of a physician order [REDACTED].>2. Documentation in Resident #78's physician order [REDACTED]. The physician order [REDACTED]. On 6/14/17 at 8:40 a.m., this finding was confirmed with the Clinical EMR Specialist.",2020-09-01
61,AROOSTOOK HEALTH CENTER,205018,PO BOX 410,MARS HILL,ME,4758,2019-06-19,756,D,0,1,YCT711,"Based on record reviews and interview, the facility failed to ensure that the Consultant Pharmacist conducted a monthly medication regimen review (MRR) for 1 of 5 sampled residents reviewed for unnecessary medications (#24). Finding: On 6/19/19 at 8:12 a.m., Resident #24's clinical record was reviewed and revealed that the Consultant Pharmacist conducted a monthly MRR on 3/8/19 and 5/22/19. The clinical record lacked evidence that a MRR was completed in the month of (MONTH) 2019. On 6/19/19 at 9:28 a.m., during an interview with the Registered Nurse (RN) Minimum Data Set (MDS) Lead, the surveyor confirmed this finding. The RN MDS Lead indicated that Resident #24 was out of the building the day the Consultant Pharmacist came to do the MRR and may have thought Resident #24 was discharged but the resident was not discharged .",2020-09-01
62,AROOSTOOK HEALTH CENTER,205018,PO BOX 410,MARS HILL,ME,4758,2019-06-19,812,D,0,1,YCT711,"Based on observations and interviews the facility failed to ensure the kitchen was maintained in a clean and sanitary manner for a food mixer for 3 of 3 days of survey (6/17/19, 6/18/19, and 6/19/19). The facility also failed to ensure plates and bowls were air dried before stacking on a shelf for 1 of 3 days of survey (6/18/19). Findings: On 6/17/19 during the initial kitchen tour the surveyor observed the food mixer had chipped and missing paint on mixer arm, the top and the side of the mixer creating uncleanable surfaces. On 6/18/19 at 8:15 a.m. during a second kitchen tour a surveyor observed the food mixer had chipped and missing paint on the arm, on the top and on the side. A surveyor confirmed this finding with the Food Service Director at the time of the observation. On 6/19/19 at 10:55 a.m. during an observation and interview with the Food Service Director, a surveyor confirmed that the food mixer had chipped and missing paint creating an uncleanable surface.",2020-09-01
63,AROOSTOOK HEALTH CENTER,205018,PO BOX 410,MARS HILL,ME,4758,2018-12-10,656,B,1,0,246711,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on clinical record reviews, facility policy review, and interviews, the facility failed to follow a care plan in the area of falls for 2 of 3 residents reviewed (Resident #1, Resident #2). Findings: The facility's policy Fall Prevention/Assessment, revised 3/7/14, defines a fall as an unplanned descent to the floor, with or without injury to the patient and includes falls that a staff member attempts to minimize the impact of the fall by easing the patient's descent to the floor or in some manner attempted to break the fall. It includes a PR[NAME]EDURE that indicates it will be documented on the resident plan of care that they are at risk for falls, appropriate interventions will also be documented here, and to notify the provider (physician) and family/significant other of fall as soon as possible or if injury requires immediate treatment then notify the family immediately regardless of the time of day. This policy also directs staff to complete an incident report (RL6) and document facts relevant to the fall and any follow up actions. 1. Resident #1's care plan, under the care area of falls, included an intervention, dated 10/11/18, that directed staff to follow the facility fall protocol. Resident #1's clinical record contained a paper, dated 10/16/18, that identified 3 family members that can be contacted regarding concerns with Resident #1 and that the Resident Representative, listed as #1, is to be attempted to be contacted first. On 10/20/18 at 12:37 p.m., Registered Nurse (RN) #1 documented in the clinical record that Resident #1 tried to move him/herself to bed and landed on the floor and that the physician was informed of the incident. The facility was unable to provide an incident report (RL6) for this fall and there is no evidence of the Resident Representative being notified. On 10/29/18 at 7:52 p.m., RN #2 documented in the clinical record that at approximately 12 p.m., Resident #1 had a fall with no injuries. This note indicated the family and physician were notified. On 12/10/18 at 12:55 p.m., during an interview with a surveyor , RN #2 stated that she did not attempt to call the Resident Representative for Resident #1 but called the third person on the list and she did not complete an incident report (RL6) because she didn't have a pin number for access to the electronic system. On 12/10/18 at 11:55 a.m., during an interview with the Director of Nursing (DON), a surveyor requested the incident reports (RL6) for Resident #1's falls that were documented in the clinical record on 10/20/18 and 10/29/18. The DON was unable to provide an incident form for either date. The DON stated that both nurse's on duty those days were [MEDICATION NAME] and usually the ask another nurse on duty to complete the forms. The surveyor confirmed that there is no evidence of an incident report (RL6)completed or that the Resident Representative was notified of the incidents. 2. Resident #2's care plan, under the care area of falls, included an intervention, dated 3/29/18, that directed staff to follow the facility fall protocol. On 12/1/18 at 6:00 p.m., a Licensed Practical Nurse documented that Resident #2 was with no complaints from a fall that occurred on 11/29/18. On 12/10/18 at 1:25 p.m., during an interview with the Administrator, the surveyor requested to see a copy of Resident #2's incident report (RL6) for the 11/29/18 fall that was mentioned in a 12/1/18 nurse's note. On 12/10/18 at 2:33 p.m., during an interview with a surveyor, the DON stated that she found a Certified Nursing Assistant (CNA) Shift Report that indicated Resident #2 did have a fall on 11/29/18. The DON stated the RN #2 was on duty and did not complete an incident report (RL6) and this was the first time that the DON was aware of this incident. She also stated that we notify Resident #2's son regarding any falls. The surveyor confirmed that there is no evidence of an incident report (RL6) or a nurse's note in the clinical record regarding this incident and the Resident Representative was not notified of the incident.",2020-09-01
64,BANGOR NURSING & REHABILITATION,205020,103 TEXAS AVE,BANGOR,ME,4401,2019-07-17,584,B,0,1,2DG411,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations and interview, the facility failed to adequately provide housekeeping and maintenance services necessary to maintain the building in good repair, and sanitary condition, for 1 of 1 environmental tour. Finding: On 7/10/19 from 9:30 a.m. to 10:00 a.m., a surveyor conducted an Environmental Tour on the Skilled and Long Term Care units with the District Manager and Maintenance Director in which the following observations were confirmed: -In room [ROOM NUMBER], the veneer is peeling off the dresser drawer. -In room [ROOM NUMBER], the floor is soiled with dirt and debris. On the floor, to the right of the hand sink, the cove base is pulled away from the wall creating an uncleanable surface. -In room [ROOM NUMBER], the wall at the foot of the beds is scuffed with black marks and the paint is chipped off. -In room [ROOM NUMBER]-1, the enamel on the metal grab rails are chipped creating an uncleanable surface. -In room [ROOM NUMBER]-1, the enamel on the metal grab rails are chipped creating an uncleanable surface. -In room [ROOM NUMBER]-1, the enamel on the left metal grab rail is chipped creating an uncleanable surface. -In room [ROOM NUMBER]-1, the enamel on the left metal grab bar is chipped creating an uncleanable surface. -In room [ROOM NUMBER], the wall to the right of the entrance of the room has chipped, peeling paint, exposing metal. The floor in the bathroom is soiled with dirt and debris. The door frame, at the entrance of the room, has paint chipped off. -In room [ROOM NUMBER], the wall at the head of the bed has paint chipped off. The door frame, at the entrance of the room, has paint chipped off. -In rooms [ROOM NUMBER], the bottom of the door frame, at the entrance of the rooms, has paint chipped off. On 7/10/19 from 10:00 a.m. to 10:05 a.m., a surveyor conducted an Environmental Tour on the secured Dementia Unit with the District Manager and Maintenance Director in which the following observations were confirmed:",2020-09-01
65,BANGOR NURSING & REHABILITATION,205020,103 TEXAS AVE,BANGOR,ME,4401,2019-07-17,622,E,1,0,2DG411,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on record review and interview the facility failed to re-admit a resident from a hospital during an appeal of a facility-initiated discharge and failed to ensure the physician documented the care need (s) the facility could not meet for 1 of 1 hospitalized resident issued a facility-initiated discharge notice (#253). Finding: Review of Resident #253's clinical record reveals that he/she was admitted in (MONTH) of (YEAR) with [DIAGNOSES REDACTED]. On [DATE] the record reveals Resident #253 was transferred to an acute care hospital and was subsequently admitted for treatment of [REDACTED].#253 remains hospitalized . A review of hospital records reveals that on [DATE] the hospital communicated with the facility that Resident #253 was ready for discharge, the facility responded indicating Our facility can no longer meet (Resident #253) needs due to (Resident #253) bariatric status. The hospital responded was (Resident #253) not bariatric prior to her admission. On [DATE] Bangor Nursing & Rehabilitation Center sent a letter to Resident #253 indicating your bed hold has expired, and you have been discharged from our facility. We will not be able to accept you to Bangor Nursing & Rehabilitation Center on the basis that your current needs cannot be met by our facility. The letter provided information on how the resident could appeal this decision, and further informs the resident a nursing facility may not transfer or discharge a resident until a decision is rendered if that resident has requested a hearing within 10 days of receipt of notice. Unless the health or safety individuals is in immediate risk or immediate transfer or discharge is necessitated by the resident's urgent medical need. Hospital progress notes dated [DATE] indicate that the [MEDICAL CONDITION] has resolved and Resident #253 medically ready for discharge. On [DATE] Resident #253 appealed the notice of facility-initiated discharge and requested a hearing. Further review of Resident #253's clinical record does not provide documentation by the physician to indicate the specific resident needs that the facility could not meet, facility efforts to meet those needs; and the specific services any receiving facility will provide to meet the needs of Resident #253 that cannot be met at Bangor Nursing & Rehabilitation Center. On [DATE] Resident #253's appeal hearing was held, the decision of that hearing is as follows Bangor Nursing & Rehabilitation Center did not meet the regulatory requirements for an involuntary discharge of (Resident #253). Bangor Nursing & Rehabilitation Center shall readmit (Resident #253) to (his/her) previous room if available or immediately upon the first availability of a bed in a semi-private room if (Resident #253) (A) Requires the services provided by the facility; and (B) Is eligible for Medicare skilled nursing facility services or Medicaid nursing facility services. As of [DATE] Resident #253 remains in the hospital awaiting placement to the facility, 177 days after the request for appeal. On [DATE] at 1:09 p.m. in an interview, a surveyor confirmed with the Director of Nursing (DON) that there is no documentation by a physician indicating the specific resident needs that cannot be met at the facility. A surveyor also confirmed with the DON that the resident has not been readmitted to the facility pending appeal and decision for re-admission. The DON stated the facility realized they cannot accommodate the needs of Resident #253 due to the resident's increasing weight and need for [MEDICAL CONDITION] treatment.",2020-09-01
66,BANGOR NURSING & REHABILITATION,205020,103 TEXAS AVE,BANGOR,ME,4401,2019-07-17,623,B,0,1,2DG411,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record reviews and interviews, the facility failed to issue a transfer/discharge notice to 1 of 2 sampled residents (#38) and failed to notify the Ombudsman Office of a facility initiated transfer/discharge to an acute care facility for 1 of 1 sampled residents reviewed for hospitalization (#253). Findings: 1. Resident #38's clinical record was reviewed and documentation indicated the Resident #38 was transferred to an acute care hospital, per family member's request, on 6/30/19 and was admitted . The surveyor was unable to find evidence of a written transfer/discharge notice being provided to Resident #38 or the Resident's Representative. On 7/17/19 10:57 a.m., during an interview with a surveyor, the Unit Secretary stated at the time of a Resident's discharge, she completes the Checklist for Closed Charts. She states that the nurse that completed the Physician order [REDACTED]. Usually, a copy of the discharge/transfer notices are put in the Social Worker's box and then they are placed in the clinical record under the Social Services section. The Unit Secretary was only able to find a blank transfer/discharge notice and was unable to find a completed notice in the closed record but she would check with the Licensed Social Worker (LSW) to see if she has a copy. On 7/17/19 at 11:47 a.m., during an interview with a surveyor, the LSW stated that she cannot find the transfer/discharge notice for Resident #38's transfer/discharge to the hospital on [DATE]. She states that it was an Agency Nurse that sent Resident #38 to the hospital but the practice should be that everyone that gets sent to the hospital receives a transfer/discharge notice. 2. Resident #253's clinical record was reviewed and documentation indicated that Resident #253 was transferred to an acute care facility on 1/6/19, and was admitted . On 7/17/19 at 11:47 a.m., during an interview with a surveyor, the LSW stated that she was unaware of having to notify the Ombudsman's office for facility initiated transfer/discharges and has not notified them of any.",2020-09-01
67,BANGOR NURSING & REHABILITATION,205020,103 TEXAS AVE,BANGOR,ME,4401,2019-07-17,626,D,1,0,2DG411,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on record review and interviews, the facility failed to readmit 1 of 1 Resident (#253) back to the facility following a hospitalization . Finding: On 1/6/19 Resident #253 was transferred to the hospital and subsequently admitted for treatment of [REDACTED].#253 remained hospitalized . A review of the Notice of Bed Hold indicated, Effective Date of Notice: 1/6/19, and Duration of Bed Hold: 10 days The facility Bed Hold policy indicated, If a bed hold is not available or obtained, (the facility) will always accept a referral for re-admission of a patient sent to a hospital, and if we can meet your needs at that time of referral and have and appropriate bed, then we will readmit you. Documentation in a Hospital Medicine Progress Note by physician #2 dated 1/20/19 states under Assessment/Plan, Patient medically ready for discharge - awaiting SNF (skilled nursing facility) placement. Care manager assisting. Communication from the electronic referral system between the hospital and the facility shows communication from the hospital on [DATE] at 2:20 p.m. that patient ready for d/c (discharge), from the facility on 1/14/19 at 2:54 p.m. that Status changed to decline. No appropriate bed. Patient too complex., from the facility on 1/14/19 at 3:47 p.m. that Our facility can no longer meet his/her needs due to his/her bariatric status. Review of Resident #253's clinical record does not provide documentation by the physician to indicate the specific resident needs that the facility could not meet, facility efforts to meet those needs; and the specific services any receiving facility will provide to meet the needs of Resident #253 that cannot be met at Bangor Nursing & Rehabilitation Center. From 7/15/19-7/17/19 during onsite survey visits, the facility census was 52 with total available beds at 60. The facility admitted on e resident after the surveyor's entrance to the facility. On 7/17/19 at 1:09 p.m. in an interview, a surveyor confirmed with the Director of Nursing (DON) that the DON stated the facility realized they cannot accommodate the needs of Resident #253 due to the Resident's increasing weight and need for [MEDICAL CONDITION] treatment. The Resident was admitted to the hospital with [REDACTED]. As of 7/17/19 Resident #253 has not been readmitted to the facility.",2020-09-01
68,BANGOR NURSING & REHABILITATION,205020,103 TEXAS AVE,BANGOR,ME,4401,2019-07-17,684,E,0,1,2DG411,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interviews, the facility failed to follow a physician order [REDACTED].#14). Finding: Documentation in Resident #14's clinical record, under the Therapy section, indicated the resident received physical therapy between 4/25/19 and 6/5/19. On 6/5/19, the Physical Therapist wrote that Resident #14's progress had plateaued and that nursing staff may resume the FMP for ambulation that was in place. Resident #14's primary physician signed this as an order to continue the FMP for ambulation. A review of the Resident #14's clinical record indicated there is no documented evidence that his/her FMP for daily ambulation is being followed. On 7/17/19 at 10:47 a.m., in an interview with the surveyor, Resident #14 stated he/she would like to ambulate everyday but staff are not doing it. On 7/17/19 at 2:40 p.m., in an interview with the surveyor, the Assistant Director of Nursing (ADON) stated Resident #14 does have a FMP for ambulation dated 5/29/19. The ADON was unable to find documentation in Resident #14's clinical record that the FMP was being followed. The ADON confirmed with the surveyor that the FMP for ambulation was not put in place on 6/5/19 and is not being followed.",2020-09-01
69,BANGOR NURSING & REHABILITATION,205020,103 TEXAS AVE,BANGOR,ME,4401,2019-07-17,758,D,0,1,2DG411,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interviews, the facility failed to ensure an as needed (PRN) anti-psychotic medication met the required 14-day limit, for 1 of 5 residents reviewed for unnecessary medications (#27). Finding: Resident #27's Physician order [REDACTED]. The Physician order [REDACTED]. Review of the electronic Medication Administration Record [REDACTED]. On 7/17/19 at 12:52 p.m., during an interview with a surveyor, the Director of Nursing (DON) reviewed the EMAR while the Assistant DON (ADON) reviewed the Physician order [REDACTED]. The surveyor confirmed this finding during this joint interview with the DON and ADON.",2020-09-01
70,BANGOR NURSING & REHABILITATION,205020,103 TEXAS AVE,BANGOR,ME,4401,2019-07-17,812,F,0,1,2DG411,"Based on observations, interviews and review of the facility's Kitchen/Dining Room Coolers, Freezer and Dry Storage Temperature Log sheet, the facility failed to ensure refrigerator temperatures were maintained at 41 degrees Fahrenheit (F) or below for 5 consecutively taken temperatures. The facility failed to maintain Potentially Hazardous Foods (PHF) at a temperature of 41 degrees F or below prior to meal services for 7 meals. The facility failed to ensure foods kept in the walk in freezer had no signs of negative outcome (freezer burn, food dried out or ice crystal build up) for 1 of 1 days of survey (7/15/19), in addition the facility failed to ensure the kitchen was maintained in a clean and sanitary manner for the large food mixer located near the cooks refrigerator that had chipped paint and the ice machine that has a side fan that is dust covered for 2 of 3 days of survey. (7/15/19 and 7/16/19) Findings: 1. On 7/15/19 at 11:00 a.m., during the initial kitchen tour, the refrigerator labeled as the reach in dietary aide refrigerator temperature was observed at 52 degrees F. The Dining Services Director (DSD) was made aware and placed a second thermometer in the refrigerator and stated it would be monitored. Review of the Kitchen/Dining Room Coolers, Freezer and Dry Storage Temperature Log sheet indicated that on 7/10/19, 7/11/19 and 7/12/19 the temperature of the reach in Dietary Aide refrigerator was above 41 degrees F. The DSD was made aware the food was moved to a different refrigerator and the refrigerator was repaired and the food was put back in the reach in Dietary Aide refrigerator. On 7/14/19 the temperature for the reach in Dietary Aide refrigerator was taken twice with both temperatures above 41 degrees F. 2. On 7/15/19 at 11:00 a.m. Also, during the initial tour of the kitchen, the surveyor observed the walk-in freezer have ice buildup on the left side of the door, on the floor, shelves and on packages of food stored on the left side of the walk-in freezer. The following foods were covered with ice crystals, were not sealed to prevent freezer burn, and were not sealed 6 biscuits in an unsealed bag, 24 croissants on a tray that were not properly covered, 1/4 bag of unsealed small onions, 1 angel food cake with ice crystal build up, 4 chicken breasts with ice crystals build up, 1 loaf of white bread, 12 Salisbury steaks in an unsealed container, 2 bagels in an unsealed bag, 2 quarts of beans with ice crystal build up. During this tour the surveyor observed the large food mixer had chipped and missing paint on the mixer arm, and the sides of the mixer creating uncleanable surfaces and the ice machine has a vented side panel that was dust covered. The surveyor confirmed these findings with the DSD at the time of the observation. 3. On 7/16/19 at 8:30 a.m., during a follow up tour of the kitchen the surveyor observed the temperature in the reach in dietary aide refrigerator (using the internal thermometer) was 52 degrees F, The Surveyor made the Kitchen Supervisor/cook aware who stated that she had not taken the temperatures for the refrigerators that morning. At 8:30 a.m. the surveyor and the Kitchen Supervisor/cook reviewed the digital temperature for the reach in Dietary Aide refrigerator, the reading was 56 degrees F. The service department was called to come in and repair the refrigerator. The surveyor observed the large food mixer was still in use with the chipped paint on the mixer arm and the sides. DSD was made aware and the large food mixer was taken out of use until repaired. 4. On 7/16/19 at 9:00 am. the DSD came to the kitchen and took the temperature of an unopened half gallon of 2 % milk, using a digital thermometer the temperature of the milk was 57 degrees F, other diary items in the refrigerator were temped, the yogurt was at 54 degrees F. At 9:15 a.m. The dietary aide took the temperature of a homemade health shake using a digital thermometer, the temperature was 57 degrees F. The items in the refrigerator were removed and discarded. During review of the temperature log the surveyor confirmed with the DSD that the dairy products that were in the reach in Dietary Aide refrigerator were used for all 3 meals on 7/14/19 and 7/15/19 and 1 meal on 7/16/19. The surveyor confirmed the above finding at the time of the observation and that the DSD was not made aware of the elevated temperatures on 7/14/19.",2020-09-01
71,BANGOR NURSING & REHABILITATION,205020,103 TEXAS AVE,BANGOR,ME,4401,2019-07-17,880,E,0,1,2DG411,"Based on Infection Control Policy and Procedure review and interviews, the facility failed to perform a risk assessment to identify where waterborne pathogens (Legionella) could grow and spread, failed to develop and implement a water management policy and procedure and failed to specify testing protocols. Finding: On 7/17/19 at 12:19 p.m., the surveyor and the facility's Infection Preventionist (IP) reviewed the facility's infection control policies. There is no policy and procedure for water management. There is no evidence of a risk assessment being completed to determine growth areas for waterborne pathogens such as Legionella or other pathogens. In an interview with the IP, during the policy reviews, she stated she was unaware that Legionella is part of her infection control program and she has never seen a policy and procedure for water management. On 07/17/19 at 12:48 p.m., in an interview with the surveyor, the Administrator stated he was aware of the Legionella testing, but the facility did not have policies and procedures in place. He stated in May, 2019, the local City Water Management drained a fire hydrant outside the facility. He stated the City Water Management took water samples from the facility for testing, but he did not know what those tests were for. The Administrator stated he drafted a Legionella policy at that time in May, but was waiting for the results of the water tests that the City Water Management had taken before developing a water management program. The Administrator stated he does not have the results of the City's water tests and the facility has no documentation of water testing for Legionella. On 7/17/19 at 12:48 p.m., the Administrator confirmed with the surveyor that the facility has not completed a risk assessment to determine potential areas of microbial growth, there is no policy or procedure for Legionella in place and there are no documented results of testing for Legionella or other opportunistic pathogens in water.",2020-09-01
72,BANGOR NURSING & REHABILITATION,205020,103 TEXAS AVE,BANGOR,ME,4401,2018-08-08,584,D,0,1,FGCE11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations and interviews, the facility failed to maintain floors, walls and ceiling tiles in good repair for one of one environmental tour. On 08/8/18, between 12:10 p.m. and 1:00 p.m., the surveyor, the Maintenance Director and the District Manager of Healthcare Services completed an environmental tour. Findings: 1. room [ROOM NUMBER]-A, the threshold floor to the bathroom is lined with built up dirt and debris. 2. room [ROOM NUMBER], there are two tiles missing and built up dirt on the grout between tiles. 3. room [ROOM NUMBER], two tiles in front of the bathroom door are cracked creating an uncleanable surface and there is built up dirt around the base of the toilet. 4. room [ROOM NUMBER], ceiling tile over Bed-B is stained. 5. In the whirlpool room, to the left of the entrance, the cove base is pulled away from the wall. 6. In the Skilled living room, the carpeting on the walls is soiled with dried on liquids and dirt. In the corridor, across from the dining tables, a ceiling tile is stained. Above the fire place area, six ceiling tiles are stained. The above findings were confirmed with the surveyor by the Maintenance Director and the District Manager of Healthcare Services at the time of the observations.",2020-09-01
73,BANGOR NURSING & REHABILITATION,205020,103 TEXAS AVE,BANGOR,ME,4401,2018-08-08,600,D,1,1,FGCE11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on interviews, written and verbal statements and review of the facility reportable incident form, the facility failed to ensure that 1 of 1 resident reviewed (Resident #48) was free from physical abuse. Finding: A review of the facility's Nursing Facility Reportable Incident Form dated 5/21/18, indicated that on 5/21/18 at approximately 2:20 p.m. a housekeeper reported to the Director of Nursing (DON) that Resident #48 was kicking the housekeeping cart and that Certified Nursing Assistant #1 (CNA #1) approached Resident #48 and saw Resident #48 slap CNA #1 who then hit Resident #48 back. During the facility's internal investigation, a written statement from the housekeeper reports that Resident #48 started kicking her cart, housekeeper asked Resident #48 to please stop, CNA #1 came over to Resident #48 and asked him/her to stop kicking, he/she then yelled at CNA #1 to stop telling him/her what to do. Resident #48 attempted to get out of his/her wheelchair and CNA #1 told Resident #48 to sit back down and not to come near her. Housekeeper saw Resident #48 hit CNA #1 and saw CNA #1 hit Resident #48 back. The written statement further indicates that CNA #1 yelled at Resident #48 using vulgar language to get away from her and not to touch her. A written statement from CNA #2 who was working with CNA #1 states that CNA #1 was witnessed pushing Resident #48's wheelchair around out of anger. Written statement from CNA #1 states that Resident #48 was going after her and she pushed his/her chair in the opposite direction, he/she then turned around and slapped CNA #1 on the arm/shoulder. Documentation on the 'Nursing Facility Reportable Incident' Form/5 day follow up, indicated on 5/23/18 during a phone interview with the DON, the housekeeper added to her previous statements that Resident #48's spouse had just left and Resident #48 was upset, the housekeeper (witness) states that CNA #1 was standing with Resident #48 in the hallway/alcove across from Resident #48's room. The housekeeper reports that she overheard CNA #1 telling Resident #48 Don't you touch me, (using vulgar language), you treat them bad anyways, I don't blame them for leaving and after that was when Resident #48 came over to the housekeeping cart and kicked it. The housekeeper reports that she asked him/her not to kick the cart as something might break and Resident #48 responded Do you want to see a broken person?, and CNA #1 came over and Resident #48 slapped CNA #1 on the arm and CNA #1 slapped him/her back. Resident #48 and CNA #1 were flailing their hands in the air at each other and she is 100% sure contact was made by CNA #1. The housekeeper then states that CNA #1 told Resident #48 again to get away from her (using vulgar language). On 5/24/18 the DON met with CNA #2 again to go over the incident. CNA #2 reviewed her written statement from 5/21/18 and reports that CNA #1 was in the alcove with Resident #48. CNA #2 witnessed CNA #1 take ahold of the wheelchair and turn it around with force. CNA #2 reports that CNA #1 was raising her voice and telling Resident #48 not to follow her, CNA #2 stated CNA #1 was using vulgar language. CNA #2 states she did not see any physical contact but does report she saw both the resident and CNA #1 flailing their hands at each other. On 8/7/18 at 11:10 a.m., during an interview with the surveyor, the housekeeper who witnessed the incident, stated that it was late afternoon and she was cleaning Resident #48's room and heard shouting, CNA #1 was swearing at Resident #48 to sit down, he/she was attempting to stand up out of his/her chair. CNA #1 turned his/her chair quickly and Resident #48 came over to the housekeeping cart and started kicking it. The housekeeper then brought the cart half way into his/her room and CNA #1 came over and asked him/her to stop, the resident became aggressive towards CNA #1 and they started flapping their hands at each other. CNA #1 brought her arm up and she hit him/her on his/her shoulder. The housekeeper believes it was the left side. Resident #48 hit her back, the housekeeper was not sure if it was on his/her wrist or arm. CNA #1 turned to him/her and told him/her to sit down and not to touch her using vulgar language. On 8/7/18 at 2:15 p.m., in an interview with the surveyor CNA #2 stated that it was after lunch and she witnessed CNA #1 grab Resident #48's chair and pushed it quickly to the side. CNA #1 screamed don't hit me using vulgar language and said he/she hit me, then shoved the chair. On 8/7/18 at 2:45 p.m., in an interview with the surveyor, the Administrator stated that after their investigations and review of the video, they substantiated mistreatment of [REDACTED].#1's employment.",2020-09-01
74,BANGOR NURSING & REHABILITATION,205020,103 TEXAS AVE,BANGOR,ME,4401,2018-08-08,645,D,0,1,FGCE11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record reviews and interviews, the facility failed to ensure that the State mental health authority for Pre-Admission Screening and Resident Review (PASRR) was notified when the nursing home stay of a resident with a mental health [DIAGNOSES REDACTED].#11, #46). Findings: 1. A review of Resident #11's clinical record indicated he/she was admitted to the facility on [DATE] with a [DIAGNOSES REDACTED].#11 had a Pre-Admission Screening and Resident Review (PASRR) Level I screen with a determination letter, dated 5/30/18, indicating a PASRR level 1, TIME-LIMITED WAIVER, was good for only 30 days, and which directed the facility to notify the State mental health authority if the individual's stay was expected to exceed 30 days. On 8/7/18, the surveyor interviewed Resident #11 who was still present in the facility. On 8/7/18 at 9:50 a.m., during an interview with the surveyor, the Social Service Director (SSD) stated that she did not send the required information to the State mental health authority for a final PASRR Level 1 determination as was indicated on the letter for the 30 day waiver. The surveyor confirmed this finding at this time. 2. Resident #46 was originally admitted to the facility on [DATE] from another Long Term Care (LTC) facility. Resident #46's clinical record indicated Resident #46 had a medical [DIAGNOSES REDACTED].#46 had a [MEDICAL CONDITION] (other than [MEDICAL CONDITION]). Resident #46 was discharged to the hospital on [DATE] and returned to the facility on [DATE]. The hospital completed a Level 1 PASRR screen on 6/28/18. Page 2 of this screen was completed inaccurately and failed to indicate Resident #46 had a mental illness. On 8/7/18 at 9:50 a.m., during an interview with a surveyor, the Social Services Director (SSD) stated that the hospital sent the facility the Level 1 PASRR screen instead of KEPRO, the agency that determines whether a Level II screen is necessary. She stated that if page 2 is check marked all no's it does not need to be sent to KEPRO. However, page 2 was not completed correctly with Resident #46's mental illness. The SSD stated she should have checked the PASRR Level I screen when it was sent to her from the hospital to ensure that it was filled out correctly. The surveyor confirmed this finding during this interview. On 8/7/18 at 9:10 a.m. and on 8/8/18 at 9:00 a.m., a surveyor confirmed these findings in an interview with the Social Service Director.",2020-09-01
75,BANGOR NURSING & REHABILITATION,205020,103 TEXAS AVE,BANGOR,ME,4401,2018-08-08,684,E,0,1,FGCE11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interview, the facility failed to follow a physician order [REDACTED]. Findings: 1. Documentation in Resident #5's clinical record, under the physician order [REDACTED].#5 has an order, dated 7/3/18, for Do not hospitalize, Hospice referral. On 7/3/18, a nurse's note indicated that the Social Service Director was notified of the Hospice referral. On 8/8/18 at 11:12 a.m., in an interview with the Social Service Director, she stated that on 7/5/18, she phoned the referral in and left a phone message, but did not write a note in the resident's clinical record indicating the referral had been done. She also stated that she did not follow up on the referral until the surveyor addressed it on 8/8/18-23 business days later. There is no evidence in Resident #5's clinical record that a referral was made for Hospice services. 2. Resident #46's clinical record contained a progress note, dated 7/27/18, that revealed the Physician was ordering a [MEDICATION NAME] quick taper due to Resident #46 has hives. The clinical record contained a physician order, dated 7/27/18, that directed to give [MEDICATION NAME] 20 milligrams (mg) 1 tablet by mouth (PO) for 1 day then 15 mg 1 tablet PO for 1 day and then 10 mg 1 tablet PO for 1 day and then 5 mg 1 tablet PO for 1 day then stop. Review of Resident #46's Medication Administration Record [REDACTED]. On 8/8/18 at 10:46 a.m., during an interview with a surveyor, the Director of Nursing (DON) stated that she would check into why the medication wasn't administered daily as ordered. On 8/8/18 at 12:15 p.m. during an interview with the DON, the surveyor confirmed that the medication wasn't administered as ordered.",2020-09-01
76,BANGOR NURSING & REHABILITATION,205020,103 TEXAS AVE,BANGOR,ME,4401,2018-08-08,761,D,0,1,FGCE11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and interview, the facility failed to remove an expired insulin vial from the supply available for use in 1 of 2 licensed treatment carts (Skilled Unit). Finding: The facility's PharMerica Insulin Drug Chart indicates that [MEDICATION NAME] (pens & vials) are good for 28 days. On [DATE], a surveyor and a Registered Nurse (RN) observed in the Skilled Unit licensed treatment cart, a vial of [MEDICATION NAME] for a resident with an open date of ,[DATE] and an expiration date of ,[DATE], both written in pen on the cardboard box. The [MEDICATION NAME] was dated good for 31 days. During an interview with a surveyor, the RN stated that the [MEDICATION NAME] was good for 28 days (expired [DATE]). The RN stated that the resident receives [MEDICATION NAME] in the evening and received it last evening. The surveyor confirmed the [MEDICATION NAME] was expired at this time. The RN removed the vial from the treatment cart and ordered a new one from the pharmacy. On [DATE] at 12:50 p.m., during an interview with a surveyor, the Director of Nursing (DON) and the Assistant Director of Nursing (ADON), both stated that [MEDICATION NAME] is good for 28 days. The surveyor confirmed the [MEDICATION NAME] was labeled incorrectly and was expired at this time.",2020-09-01
77,BANGOR NURSING & REHABILITATION,205020,103 TEXAS AVE,BANGOR,ME,4401,2019-08-21,550,G,1,0,QVUV11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on record reviews, interviews, and observation, it was determined the Facility has violated Resident #253's right to be free from discrimination, coercion, and interference as evidenced by the facility's refusal to readmit him/her because of the resident's known [MEDICAL CONDITION], attempts to transfer Resident #253 to another nursing facility without the resident's consent, and by not honoring a Hearing Officer's decision to re-admit, for 1 of 1 resident's reviewed (Resident #253). Finding: A review of the Facility Assessment, dated [DATE], indicated the Facility cared for individuals with a [DIAGNOSES REDACTED]. Resident #253 was admitted to the Facility in (MONTH) of (YEAR) with a [DIAGNOSES REDACTED]. The resident's Minimum Data Sets (MDS) 3.0 assessments, dated [DATE] and [DATE], indicated the following: -He/she required extensive assistance with the support of two or more persons providing physical assistance for bed mobility, toilet use, and personal hygiene; -He/she was totally dependent with the support of two or more persons providing physical assistance with bathing; -He/she was occasionally incontinent of urine (less than 7 episodes of incontinence over a 7-day period) per the [DATE] MDS and was always continent of urine per the [DATE] MDS -He/she was always continent of bowel -He/she did not require a toileting program to manage his/her continence. -His/her weight was 473 pounds and 481 pounds respectively. -He/she was at risk for pressure ulcers but did not have pressure ulcers. -There was no active discharge plans and the resident did not want to talk to anyone about the possibility of leaving this Facility and returning to live and receive services in the community. On [DATE], the primary care provider (PCP) assessed the resident's leg and decided the resident needed intravenous (IV) antibiotics at the hospital; therefore, the patient was transferred to the hospital and was admitted . The MDS 3.0 assessment, dated [DATE], indicated the following: -This discharge was unplanned and it was anticipated the resident would return to the Facility. -He/she required extensive assistance with bed mobility, toilet use, and personal hygiene. -He/she was totally dependent on staff for transfer and bathing. -He/she was always continent of urine and bowel. -His/her weight was 578 pounds. -He/she did not have any pressure ulcers. -There was not an active discharge in place for the resident to return to the community. Between admission in (MONTH) (YEAR) through [DATE], there was no evidence that the Facility was unable to meet this resident's needs despite his/her [DIAGNOSES REDACTED]. Written communication between the hospital and the Facility, dated [DATE] and [DATE], was reviewed and indicated the following: -The resident was concerned about losing his/bed at the Facility ([DATE]). -The Facility was notified that the resident was ready for discharge ([DATE]). -The Facility representative informed the hospital that the resident's readmission status was changed to declined; No appropriate bed; and Patient too complex ([DATE]). -The Facility representative wrote Our facility can no longer meet (Resident #253) needs due to (Resident #253) bariatric status. On [DATE], the Facility sent a letter to Resident #253 indicating your bed hold has expired, and you have been discharged from our facility. We will not be able to accept you to Bangor Nursing & Rehabilitation Center on the basis that your current needs cannot be met by our facility. The letter provided information on how the resident could appeal this decision, and further informed the resident .a nursing facility may not transfer or discharge a resident until a decision is rendered if that resident has requested a hearing within 10 days of receipt of notice. Unless the health or safety individuals is in immediate risk or immediate transfer or discharge is necessitated by the resident's urgent medical need. On [DATE], four days after the discharge letter, Resident #253 appealed the notice of Facility-initiated discharge and requested a hearing. On [DATE], an appeal hearing was held. The appeal decision was as follows: Bangor Nursing & Rehabilitation Center did not meet the regulatory requirements for an involuntary discharge of (Resident #253). Bangor Nursing & Rehabilitation Center shall readmit (Resident #253) to (his/her) previous room if available or immediately upon the first availability of a bed in a semi-private room . On [DATE] at 1:09 p.m., during the Facility's most recent Federal survey, the Director of Nursing (DON) was interviewed. It was confirmed, with the DON, that Resident #253 had not been readmitted to the Facility pending the appeal process, had not been readmitted after the appeal hearing decision, and that there was no documentation, by a Physician, that indicated any specific need that the resident required that the Facility could not meet. The Facility was issued a statement of deficiencies, dated [DATE], for regulatory violations (F622 and F6262) regarding this Facility-initiated discharge and the refusal to comply with the resident's right to return to the Facility. On [DATE], 206 days after the patient was transferred to the hospital, the Medical Director wrote a document that indicated, (Facility) does not have the staff, expertise, equipment, or infrastructure in place to care for (Resident #253) in (his/ her) current condition in a manner consistent with applicable standards of care. This opinion is based upon the following: -(Facility) does not have a wall suction unit. Without this unit, (Resident #253) would be consistently exposed to urine and this would lead to skin breakdown, pressure sores and possible infections. -Moving (Resident #253) in bed to provide skin care and hygiene support requires assistance from 3 to 4 CNAs. The staffing ratios in nursing homes generally and at (Facility) specifically make this not feasible. If (Facility) was required to support this level of staffing, it would negatively impact care of other patients at (Facility). -(Facility)cannot institute [MEDICAL CONDITION] treatment. It does not have access to specialized staff or equipment. In fact, there is none available in the greater Bangor area. -(Facility) is not permitted to restrict (Resident #253) diet in any way as this violates her rights per applicable nursing home regulations. This includes not being able to prohibit third parties from bringing in outside food that exacerbates (his/her) obesity and heart failure, and BNRC cannot prevent (Resident #253) from ordering fast food to be delivered to the facility. -Applicable nursing home regulations require that (Facility) care for (Resident #253's) overall wellbeing including (his/her) psychosocial needs. To meet this standard in the context for (Resident #253) (Facility) may be in a position to have to modify its physical infrastructure and hire additional CNAs and medical staff with specific expertise, among other possible operational impacts. On [DATE] between 9:30 a.m. and 10:00 a.m., the Administrator and DON were interviewed, and they indicated the following: -The Facility could not readmit Resident #253 related to his/her need for [MEDICAL CONDITION] treatment and currently there was no clinic in the greater Bangor area. -The Facility could not evacuate Resident #253 out of his/her room in an emergency. -The amount of staff required to take care of Resident #253 would take away from the care of other residents at the Facility. This investigation through a review of the resident's medical records from the Facility and the hospital, interviews, and/or an observation determined the following: -At the hospital, Resident #253's is utilizing a PureWick female catheter attached to wall suction. However, there was no indication that this treatment would be required upon readmission to the Facility. -Resident #253's [MEDICAL CONDITION] was not a new [DIAGNOSES REDACTED]. In addition, [MEDICAL CONDITION] treatment is available in the Bangor area. -Resident #253 required the assistance of 2 or more staff prior to being admitted to the hospital on [DATE]; therefore, the number of staff to care for this resident was not a new issue impeding the resident's return to the Facility. -Resident #253 has not experienced a significant weight gain while in the hospital. The resident's weight was 578 pounds when he/she was transferred to the hospital on [DATE] and his/her weight was 587 pounds on [DATE]. -The resident's wheelchair was too wide to fit through the doorway and staff had been instructed on ways to transfer the resident to his/her wheelchair outside of his/her room. On [DATE] at 9:30 a.m., the current Administrator indicated a mock evacuation had been conducted (prior to hospitalization ) with three firemen from the Bangor Fire Department and they were able to evacuate Resident #253 from his/her room. On [DATE] at 3:00 p.m., the Assistant State Fire Marshall, confirmed that the expectation for Long-Term Care Facilities was to protect residents in place and evacuation is considered a last resort. He stated that he had a conversation with the Bangor Fire Chief to verify the fire departments ability to evacuate Resident #253 in the event of an emergency and the Bangor Fire Chief stated, Bangor Fire would be able to remove the resident in an emergency. -On [DATE] at 10:10 a.m., the following equipment, which is owned by Resident #253 and stored in the Facility's garage, was observed: an electric bariatric transfer lift rated to lift [PHONE NUMBER] pounds; an electric-hand cranked bed that is rated for 650 pound capacity; one electric-hand crank bed that is rated for 1000 pound capacity; a bariatric commode; and a bariatric wheelchair. During a further review of Resident #253's clinical record, the following was noted: -Resident #253 was receiving counseling services between (MONTH) (YEAR) to (MONTH) (YEAR). Resident #253 discussed his/her concerns about remaining in the Bangor area to be close to his/her family; his/her concerns about his/her family members' health and wellbeing; his/her feelings about food, food and fluid restriction, and obesity; his/her fear and concern about the Facility trying to force him/her out of the nursing home and send him/her to another facility. -A Social Services Note, dated [DATE], indicated the resident was informed of his/her Medicare 100th day was [DATE] and the resident asked about remaining at this facility as LTC (Long-Term Care) because (he/she) has nowhere else to go. (He/She) states the staff here knows (him/her) and (he/she) is very comfortable with our staff. Informed (him/her) that (he/she) could remain here. -A Social Service Note, dated [DATE], indicated the following: the Licensed Social Worker (LSW) discussed with the resident the possibility of perhaps moving to a different facility to better accommodate (his/her) needs; the resident indicated that he/she did not want to move from the Facility as he/she waited two years to be able to be admitted to the Facility; and that a meeting would be held on [DATE] to discuss concerns from staff. -Social Service Notes, between [DATE] and [DATE], indicated the Facility was attempting to find a facility to transfer the resident to and several facilities were contacted regarding the potential transfer. These attempts were made without the resident's consent and after he/she had expressed on [DATE] that he/she did not want to move. - A plan of care meeting was held on [DATE] with Resident #253, Resident #253's family members, the Assistant DON, the Rehabilitation Services Manager, and the Social Service Director present. The meeting note indicated there was discussion about the resident's weight gain; the resident's poor choices with food; that he/she had ordered out often; and he/she frequently stayed up at night requesting sandwiches and snacks. The resident indicated that he/she was not getting what he/she ordered from the kitchen. The note indicated the dietary department had worked very closely with Resident #253 multiple times to help him/her lose the weight. Resident #253 stated that he/she was addicted to food. The notes also indicated that the resident stated that he/she was worried that he/she would be kicked out of BNRC, despite being told that he/she was the key to his/her well-being, and that he/she needed to make better choices and get himself/herself back on that losing track again. There was no documentation to indicate that the Interdisciplinary Team identified the reasons and causes for the resident's deviation from the care plan related to the resident's weight and implemented necessary changes for resident success. - On [DATE], the resident was seen by his/her counselor. The counselor documented the following: Patient was in bed resting. Patient was in a sad mood, and (he/she) was upset. Patient stated, 'I had a meeting today. The social worker came in and told me that I would have to go somewhere else where I was safe, and she wanted me to sign papers. I didn't sign them and I'm tired of them moving me all around this state because I'm obese and they don't want to lift me.' Patient was crying and feeling hopeless, helpless, and judged. Patient was able to talk about feeling that (he/she) was being treated this way because of (his/her) weight. Patient feels they are trying to get rid of (him/her) because it takes 3 people to move (him/her). Patient feels that they'd rather have (him/her) in bed than to get someone to move (him/her). On [DATE] at 12:25 p.m., the Facility's DON, confirmed Resident #253 had not wanted to leave the Facility and that resident's greatest concern was being near his/her family in Bangor. On [DATE] at 12:50 p.m., the LSW stated that prior to the resident's hospitalization , on [DATE], the Facility care team, nursing, therapy, dietary, and social services had concerns about being able to meet the resident's needs at the Facility. She confirmed that she had a talk with the resident about this concern and she confirmed the resident indicated that he/she did not want to leave the Facility. On [DATE] at 11:15 a.m., Resident #253 was interviewed in his/her room at the hospital. When asked how he/she would feel about returning to BNRC, the resident stated, I am reluctant, in a way. They had the fire department come to see if they would be able to get me out of the room, and the nurse said, while the fire department was there, that they would never be able to get me out the door. I don't want them to misuse me at the nursing home. I don't think they want me there. I want to stay close to my (family) in Bangor. My (family) can't travel, and (my family) has been through so much. I worry about (my family) and want to be able to see (my family). On [DATE] at 11:47 a.m., the Facility's Medical Director was interviewed. When asked if she could reference any provider progress notes for Resident #253 that supported that the Facility was providing poor quality of care or if she could provide any notes to support that the Facility was unable to meet Resident #253's care needs, she stated, There are no provider notes to support that we could not meet that resident's needs. She further stated, (Resident #253) was sent to the hospital on [DATE]. I sent (him/her) for treatment at the hospital and I expected (him/her) to come back to the nursing home. I had no knowledge that the Facility was going to discharge the resident. If the Facility accepted this resident back for care now, I would have to care for (him/her). The failure of the Facility to protect the resident's rights for a dignified existence and access to quality of care regardless of his/her [DIAGNOSES REDACTED].#253's fear of isolation from his/her family, and the Facility's refusal to allow Resident #253 to return to his/her home has resulted in increased sadness and feelings of being judged and not valued as a human being because of his/her weight.",2020-09-01
78,BANGOR NURSING & REHABILITATION,205020,103 TEXAS AVE,BANGOR,ME,4401,2017-09-14,253,E,0,1,B3L911,"Based on observations and interviews, the facility failed to maintain clean floors, ensure that doors and walls were not gouged, missing paint or chipped. The facility failed to ensure that surfaces are cleanable and room furnishings were in good repair and to provide a sanitary and comfortable environment. On 9/13/17 between 10:45 a.m. and 11:15 a.m., an environmental tour was conducted with the Director of Nursing Services (DNS), the Maintenance Supervisor, and the Chief Financial Officer. The following findings were observed: Laundry Room: -There were large clumps of dust on the floor behind the clothes dryers. -A large pile of swept up dust, dirt and food crumbs were observed on the floor in front of a waste basket. A-Unit: -In Room #15, the cove base is missing under the room radiator and the threshold is soiled with ground in dirt. -In Room #17, the threshold is soiled with ground in dirt and a piece of floor tile is missing creating an uncleanable surface. -In Room #18, under the room sink along the cove base is ground in dirt and a piece of floor tile missing creating an uncleanable surface. The paint on the wall between the sink and the bathroom is heavily marred and several areas have chipped paint. Behind Bed-B the wall is gouged and the floor is cluttered with scraps of paper. -In Room #19, the floor is soiled with debris and dried on liquid stains. -In Room #20, the entrance door is chipped and the protective kick plate is missing a piece creating an uncleanable surface. Under the sink near the cove base the floor is heavily soiled with ground in dirt and the threshold is soiled with dirt. -In Room #21, the electric outlet cover by Bed-B is cracked and missing a piece. -In Room #22, the vinyl covering on the left and right armrest of a wheelchair are cracked and torn. -In Room #23, the room floor is sticky and soiled with debris. In the bathroom is stored a commode soiled with fecal material and has been observed in this bathroom on 9/11/17, 9/12/17 and 9/13/17. The bathroom floor is heavily soiled with debris. -In Room #24, under the sink the floor tiles are heavily soiled with dirt and dried liquid stains. The cove base is peeling away from the wall and the bathroom floor is soiled with debris. The foam protective fall mat is torn creating an uncleanable surface. -In Room #25, under the sink the cove base is missing. The wall behind Bed-B is scratched and gouged. There are large drilled holes in the wall to the right of the bathroom entrance. -In Room #26, the bumper pad located between Bed-B's footboard and mattress is torn creating an uncleanable surface. The floor is soiled with debris. The window curtain is not attached to the closing rod. An electrical outlet box is not securely attached to the wall. The wall is gouged and the paint is chipped on the room radiator. The floor is soiled with dried-on spilled liquids. Skilled Unit: -In Room #1, Bed-B is missing a privacy curtain. Behind both bed headboards the wall is gouged. The dresser drawer is gouged and the molding on the top drawer is missing. The floor is soiled with debris. -In Room #2, the dresser drawers are chipped. The wall behind Bed-A and Bed-B is gouged. The floor is cluttered with debris. -In Room#3, next to Bed-A the wardrobe is missing molding around the door and the door does not latch. A paper towel holder on the wall is broken. Behind the recliner chair is a telephone plug cover that is cracked. -In Room #27, the side of the dresser is scuffed and Bed-A's wardrobe door does not shut tightly. The veneer on the entrance door and the bathroom door is peeling. Ceiling tiles are stained. -In Room #28, near Bed-A the floor is stained and soiled with debris. The area around the base of the toilet is rusted. -In Room #30, the wall next to Bed-B has several patches that are not painted to match the room color. The bathroom floor around the toilet is stained and the bathroom wall paint is chipped. -In Room #31, Bed-B bedside table is chipped on the corner and the covering is peeling off. -In Room #33, the entrance door is gouged and chipped and under the sink the floor is heavily soiled with dirt. The privacy curtain for Bed-B is off the hooks. Floor soiled with debris. Memory Care Unit: -In Room #5, the floor is soiled with debris under the beds and the floor is stained with dried on liquids. -In Room #6, the floor is scuffed with black marks. -In Room #7, the floor is sticky with dried on spilled liquids and soiled with food particles and debris. -In Room #8, the threshold is heavily soiled with ground in dirt. The floor is sticky and stained with dried on spilled liquids. -In Room #12, the cove base near the bathroom is heavily soiled with ground in dirt and debris. The above findings were confirmed at the time of the environmental tour by the DNS, Maintenance Supervisor and the Chief Financial Officer. Some findings were also confirmed prior to the tour on 9/12/17 between 10:30 a.m. and 11:30 a.m. by the DNS and the Clinical Coordinator.",2020-09-01
79,BANGOR NURSING & REHABILITATION,205020,103 TEXAS AVE,BANGOR,ME,4401,2017-09-14,323,D,0,1,B3L911,"Based on observations and interview, the facility failed to ensure lancets and insulin needles were stored in a safe manner and failed to ensure that the licensed medication/treatment cart was locked for 1 of 4 days of survey. Finding: On 9/11/17 at 7:30 a.m., the surveyor observed the licensed medication/treatment cart in the A-Unit corridor, up against the wall near Room 20. The second drawer of the treatment cart was opened approximately 3 inches and lancets were seen in the drawer. The cart contained lancets, insulin needles, insulins, and treatment supplies. There were wandering residents in the corridor and the treatment nurse was not in eye view of the cart. The Director of Nursing Services confirmed that the medication/treatment cart was left open and with a drawer opened.",2020-09-01
80,BANGOR NURSING & REHABILITATION,205020,103 TEXAS AVE,BANGOR,ME,4401,2017-09-14,371,E,0,1,B3L911,"Based on observations and interviews, the facility failed to ensure dented cans were removed from the dry good storage area, failed to date and label an opened carton of liquid whole eggs, and in addition the facility failed to maintain food preparation areas in a sanitary manner on 3 of 4 days of survey. (9/11/17, 9/12/17 and 9/13/17) Findings: On 9/11/17 at 11:00 a.m. during the initial tour of the kitchen a surveyor observed the following dented can in the dry good storage area: 1 - 6 pound can of black beans with a dent on the top rim of the can. On 9/11/17 at 11:00 a.m., in the walk in refrigerator located in the kitchen, a surveyor observed 1 opened carton of liquid whole eggs that was not labeled with an open date. Storage and handling instructions on the carton were to Use product within 3 days after opening On 9/11/17 at 11:15 a.m., on the storage rack located near the walk in freezer, the following dishes/pans were observed to be wet stacked 1- Large mixing bowl 3 - 4 inch deep full size serving pans 1 - 2 inch deep full size serving pan 1 - 6 inch deep half size serving pan 2 - 6 inch deep quarter size serving pans On 9/11/17 at 11:30 a.m. the following areas were observed to be dust covered The hood vent over the stove had dust build up on the outside edges, on the front inside and on the pipes located under the hood vent. Pipes located on the side of the stove and above the toaster were covered in dust, Pipes located behind the stove were covered in dust. These findings were confirmed with the Food Service Director, on 9/11/17 at the time of the observations. On 9/13/17 the areas were reviewed and confirmed with the Food Service Supervisor at 1:00 p.m.",2020-09-01
81,BANGOR NURSING & REHABILITATION,205020,103 TEXAS AVE,BANGOR,ME,4401,2017-09-14,441,E,0,1,B3L911,"Based on observations and interviews, the facility failed to maintain an Infection Control Program designed to prevent the development of infection related to ulcer treatment for 1 of 3 residents reviewed for ulcers (#68). In addition, the facility failed to maintain a resident's commode in a sanitary manner for for 1 of 3 commodes observed stored in resident rooms (#25). Findings: 1. On 9/11/17 at 1:44 p.m., a surveyor observed Resident #25's commode stored in the resident's bathroom in the shower area. The seat on the commode and inside the bowl was soiled with dried on fecal material. On 9/12/17 at 10:59 a.m., two surveyors observed that the same commode in Resident #25's bathroom was still soiled with the same fecal material as the day before. On 9/12/17 at 11:15 a.m., in an interview with the surveyor, the Clinical Coordinator confirmed this finding. On 9/13/17 at 11:10 a.m., during an environmental tour, a surveyor, the Director of Nursing Services (DNS) and the Maintenance Supervisor observed and confirmed that Resident #25's commode was still in the resident's bathroom with the same dried on fecal material as the two days before. 2. On 9/13/17 8:10 a.m., surveyor observed Register Nurse Charge Nurse Long Term Care Unit (RN) perform a dressing change on Resident #68. RN placed a Ziploc type bag containing wound care supplies on the resident's soiled bed sheet. The RN applied clean gloves then raised the resident's bed RN asked the Certified Nurse's aide (CNA) to assist, and they applied clean gloves then removed the Multipodus boot from resident's left foot and repositioned the sheet over the resident. CNA was holding Resident #68's left foot off the pillow with gloved hands. Without changing the gloves the RN removed the outer dressing of the wound and the primary dressing from the wound bed while using the same gloved hand to pick out the remaining dressing in the wound bed. RN then cleansed the wound with the normal saline spray bottle and gauze; then placed the spray bottle on the soiled bed sheet and asked the CNA to hold the gauze on the wound, with the same gloved hand the CNA held the gauze in place. The RN then reached into the Ziploc type bag with the same gloved hand and removed the calcium alginate dressing and proceeded to cut the alginate to fit the wound. At this time the surveyor confirmed the above findings with the RN. RN then cleansed his/her hands with sanitizer and applied a clean pair of gloves to finish the dressing change. On 09/13/17 at 11:35 a.m., the surveyor confirmed above findings with the Assistant Director of Nursing.",2020-09-01
82,ORONO COMMONS,205031,117 BENNOCH RD,ORONO,ME,4473,2018-02-13,711,D,1,0,6TZZ11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on record reviews and interview, the facility failed to ensure that a physician order [REDACTED]. (#1) Finding: Resident #1's physician orders [REDACTED]. On 2/13/17 at 12:15 p.m in an interview with the Registered Nurse, Unit Manager, the surveyor confirmed that Z-guard was intended to be given on 1/10/18 without a physcian order.",2020-09-01
83,ORONO COMMONS,205031,117 BENNOCH RD,ORONO,ME,4473,2018-02-13,761,D,1,0,6TZZ11,"> Based on record review, employee written statements and interviews the facility failed to ensure that a topical medication was secure and inaccessible to 1 of 4 Residents reviewed for quality of care. (#1) Finding: On the evening of 1/10/18 a medication cup with Z-guard (an ointment with petroleum jelly and zinc oxide used to protect the skin) was left unattended in Resident #1's room. Resident #1 ingested a small amount of the contents thinking it was a medication for him/her to drink. On 2/6/18 at 12:15 p.m., in an interview with the Registered Nurse, Unit Manager, the surveyor confirmed that the medication was left unsecured and unattended in Resident #1's room and Resident #1 attempted to drink the z-guard thinking it was a medication intended to be ingested. No ill effect was noted to the Resident.",2020-09-01
84,ORONO COMMONS,205031,117 BENNOCH RD,ORONO,ME,4473,2018-04-05,689,J,1,0,G71711,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on observations, interviews and record review, the facility failed to adequately secure windows in the residents' environment for 1 of 3 residents reviewed with a history of elopement risk. This failure resulted in a resident eloping from a window onto a side deck and wander to the front of the building (Resident #1). Findings: On 3/22/18 at 5:00 p.m., The Division of Licensing and Certification received a facility Reportable Incident Form indicating that on 3/22/18 at 2:35 p.m. Resident #1 was seen standing outside at the front door trying to get into the facility. Facility investigations indicated one of the dining room windows had been removed and there were footprints in the snow on the deck outside the dining room. The facility Reportable Incident Form indicated the Maintenance director is currently securing the windows so they cannot be tilted out/removed by residents. During a review of the medical record, Resident #1 was admitted on [DATE] to the Memory unit and a wander guard placed on resident at this time. A progress note dated 3/19/18 at 12:28 p.m., indicated that Resident #1 had been very agitated and anxious this shift, searching for his/her family and trying to get out of the building. Resident #1 had opened several windows and one in room [ROOM NUMBER] (second story room). Resident #1 had opened the window and was able to tip the window inward. Resident #1 stated it fell all the way out and landed on his/her leg. The note reflects that the window never actually fell and was not low enough to actually have fallen on residents leg. A progress note dated, 3/22/18 at 11:44 a.m. indicated that Resident #1 was very anxious and had gotten dressed in his/her coat and gloves several times that day. Each time the resident stating, was looking to go home even if he/she had to walk. At this time, outdoor clothing was removed and placed in the nursing office. A progress note dated, 3/22/18 at 3:15 p.m. indicated that the nurse was alerted at 2:35 p.m. that Resident #1 was standing outside at the front door trying to get into the facility. Resident #1 had been seen by the Clinical Reimbursement Coordinator walking past the office window, and was found attempting to come in the front door but the door would not open immediately as resident had a wander guard on. Resident #1 was assisted by the Administrator back into the facility and back to the unit. Resident #1 reported a sore hand/palm showing slight bruising. Upon return to the unit the charge nurse noted one of the dining room windows had been removed and footprints in the snow were seen on the deck outside the dining room. Resident #1 then stated he/she was going to a family members house thought to lived nearby. On 3/26/18 at 3:10 p.m., during an interview with a surveyor, the Medical Director stated that she was not aware of the elopement out the window on the 3/22/18, however, was aware that resident had gotten his/her head/shoulders out of the window yesterday (3/25/18). This was confirmed when a surveyor reviewed the following progress note dated 3/25/18 at 4:09 p.m. indicating Resident #1 was found in dining room with the window and screen up with his/her head/neck out the window. Resident stating I just wanted to get out on the deck On 3/26/18 at 1:30 p.m. during an interview with a surveyor the charge nurse stated that on the day of admission for Resident #1, the family member had revealed that when the resident was at home he/she climbed out the window and fell and fractured his/her ankle. On 3/27/18 during an interview with the surveyor the Maintenance director stated the windows on the Homestead unit (memory unit) were secured to prevent them from tilting outward on 3/22/18, and that on 3/26/18 the wedges used to prevent the windows from opening up more than 6 inches were observed. A few wedges were observed not to be at the correct height to prevent the windows from opening more than the 6 inches and were corrected immediately. A surveyor confirmed these findings with the Director of Nursing on 3/26/18 at 4:50 p.m. and on 3/27/18 at 4:00 p.m.",2020-09-01
85,ORONO COMMONS,205031,117 BENNOCH RD,ORONO,ME,4473,2018-04-05,725,E,1,0,G71711,"> Based on observations, interviews and record reviews the facility failed to ensure sufficient staff was scheduled and on duty to meet the needs of residents that reside on 2 of 2 units (Riverview unit and Homestead unit) Findings: On 3/26/18 at 12:50 p.m., during a resident interview with a surveyor, Resident #2 stated that sometimes there are only 2 certified nurse assistants (CNA's) in the evenings, resulting in the resident having to wait, what seems forever, for help to go to the bathroom. Resident #2 stated that they rang their bell one evening to go to the bathroom and nobody answered it for half an hour so the resident attempted to take themselves to the bathroom and landed on the floor (denied any injuries) and hit their head. Resident #2 stated he/she called out, and when staff finally came in the room, staff stated that they had heard someone calling but didn't know where it was coming from. In addition, the resident stated that getting showers is a problem as well. Resident #2 is supposed to get a shower once a week in the evenings and at one time they went without a shower for about 5 weeks. Resident #2 stated they did refuse a few showers because by the time the staff could get them in the shower it was 10 o'clock at night and that was too late to take a shower. Resident stated that he/she has Depression and when staff don't have time to pay attention to their needs it upsets him/her. Resident stated that approximately 1 week ago he/she was put on the commode and was left there for 45 minutes before staff came back to assist them. Resident stated if they had enough staff they would not have to wait to get help. Record review indicates that no refusals for showers are documented. For the month of (MONTH) up to the 27th, resident has received 2 showers. Incident/Accident reports reviewed, resident did have a fall on 3/23/18, call bell log indicates call bell rang for 10 minutes. On 3/26/18 at 5:00 p.m. during an interview with a surveyor, Resident #3 stated the residents can see when they are short staffed, the CNA's don't have time to spend the usual amount of time with you, like when they give you a bath they do the best they can in a short amount of time because they have so many others to take care of. A lot of the time at night they are only 2 girls on the floor. Tonight, there are only 2 girls to help us and you end up waiting for help. The girls are doing the best they can, they need more help so they can help us like we need to be helped and not have to wait so long. On 3/26/18 between the hours of 12:20 p.m. to 5:10 p.m., observations were made of the Riverview unit and the Homestead unit; surveyor observed staff on the floor for day shift. Staffing sheets indicated the medical records person was assigned to work the Riverview unit; during the surveyors' observations this staff was observed 1 time on the unit and was not seen again during course of this investigation. The medical records office is located on the bottom level of the facility. On 3/27/18 at 8:45 a.m., during an interview with a surveyor, a family member stated that how and when the resident gets help all depends on how many staff are working. When there are enough staff and I ring the bell for staff to come assist resident with toileting needs they come right away, but when they don't have the staff, and it's more often they don't have enough staff, we have to wait a while. They take good care of residents but they need more staff to help everyone the way they want to be helped in a timely manner. On 3/27/18 at 8:55 a.m., during an interview with a surveyor, Resident #4 stated that there are not enough staff to help everyone in a timely manner. He/she stated they do not wait for staffs help because if they did they would end up being incontinent in their clothes. Resident #4 stated that they are told to wait for staffs help to prevent falls but waiting 20 minutes to go to the bathroom is too long and that they would end up making a mess in their pants and that is very upsetting to them. On 3/27/18 at 9:50 a.m., during an interview with a staff member they stated that a week or twi ago there was only 2 CNA's for the entire Homestead unit. Evening shift is the worst shift, most evenings they are not able to get all care done and what they can get done is not what the residents deserve. Most get put into pajamas and we have time to wash their bottoms and that's it, then we have to go to the next person while watching the wandering residents we need more eyes on this unit to watch and monitor all the residents we have a lot of wanderers that exit seek. On 3/27/18 during an interview with a surveyor, Resident #5 stated that he/she has been known to wait 1/2 hour to 1 hour for help. The staff say they are busy feeding people or they are busy helping someone else and this happens at least once or twice a week that they don't have enough people here. When they don't come in to help me I end up soiling my pants and that is very upsetting. I have to wear briefs and have a pad on my bed. The showers were not getting done but they are getting better about giving me one once a week. On 3/27/18 at 10:10 a.m., during an interview with a surveyor, Resident #6 stated that they don't have enough staff that going to the bathroom takes forever, sometimes there is only 1 girl for all of us people that is not enough staff. And what makes it worse is when I have to go to the bathroom I need help I can't do it myself and when I have to go I have to go. On 3/27/18 at 12:20 p.m., a surveyor observed a resident sitting in front of a bathroom door crying; the surveyor asked why he/she was crying and the resident stated that they have been waiting to go to the bathroom and they could not find the CNA to help them. Surveyor made the charge nurse aware. Surveyor asked if the resident was able to take themselves to the bathroom and the charge nurse stated I think they do, but went to get a CNA to assist the resident. On 3/27/18 at 1:10 p.m., during an interview with a surveyor a staff member stated, they call office people to come in to make the numbers (making state ratio) but they don't come out of their offices. The medical record person who was listed as working the floor yesterday did not provide any resident care. We are being pushed to provide the care but without staff we are back to not providing the showers. Some resident's teeth are not being brushed they don't have the basics offered because there are not enough staff on the floor. We try our best but we need help on the floor. The resident acuity isn't like it used to be. The residents need more and more help and they don't want to give us more help on the floor. On 3/27/18 at 2:00 p.m., during an interview with a surveyor, a staff member stated that We are losing so many staff members they are all tired of working shorthanded, we are even losing agency staff, they don't want to work here because of working so short all the time. Mouth care isn't getting done and it's not because the resident is refusing, it's because there are not enough of us to do all the care the residents need and deserve. On 3/27/18 at 2:20 p.m., during an interview with a surveyor, a family member stated the facility is short staffed they usually have 2 staff and sometimes 3 but that leaves residents waiting to use the bathroom and after supper everyone has to go at the same time but the bells will ring they go in and turn them off so it isn't registered on the log. Staff tell the residents they will be right back but don't come back. The staff are trying and they are good staff, they need help to do all they have to do, as simple as giving someone a meal tray and not having any silverware or not being able to position them properly because there is no one to help them. Some residents have talked to me about being put to bed late or I had one son tell me they had to got upset about their family member not receiving showers for 2 weeks. On 3/27/18 at 3:45 p.m., during an interview with a surveyor, Resident #3 who has a Brief Interview for Mental Status (BIMS) score of 15, stated that they do not refuse their restorative program, what happens is staff will get them up out of bed using the Hoyer lift and put them in their wheelchair and they just don't come back to do the restorative part of their care. Record review of Resident #3 restorative program indicates has 8 refusals documented, 3 days with no documentation and 3 days with activity did not occur for the month of (MONTH) up to the 27th. A surveyor confirmed these findings with the Director of Nursing on 3/26/18 at 4:50 p.m. and on 3/27/18 at 4:10 p.m.",2020-09-01
86,ORONO COMMONS,205031,117 BENNOCH RD,ORONO,ME,4473,2018-05-10,804,B,0,1,D1U111,"Based on observations and interview, the facility failed to serve attractive pureed and ground foods by serving pureed and ground foods that were all the same color for 1 of 3 lunch observations on the Homestead Unit. Finding: On 5/7/18 at 12:25 p.m., two surveyors observed lunch service in the Homestead Unit dining room. The two surveyors observed 13 residents who received pureed and/or ground foods. Each plate served to the 13 residents had one half cup scoop of white mashed potato and one half cup scoop of off white colored pureed or ground chicken. There were no other foods on the plates other than a scoop of potato and a scoop of pureed or ground chicken. On 5/7/18 at 1:00 p.m., a surveyor discussed this finding with the Interim Food Service Director (FSD), and during the interview, the FSD confirmed that the 13 residents plates had a scoop of white potato and a scoop of off white chicken.",2020-09-01
87,ORONO COMMONS,205031,117 BENNOCH RD,ORONO,ME,4473,2018-05-10,809,B,0,1,D1U111,"Based on observation and interview, the facility failed to provide scheduled snacks to 19 residents on 5/3/18 and on 5/6/18. (Resident #1, #12, #14, #18, #24, #31, #41, #42, #45, #53, #60, #61, #62, #64, #67, #70, #71, #72 and #73) Finding: On 5/7/18 at 11:30 a.m. during the initial tour of the kitchen, a surveyor observed 2 trays in the walk-in refrigerator with snacks labeled with resident's names and time of snack to be delivered. On the trays were Vanilla health shakes, nutritional juice drinks, cups of cottage cheese, sandwiches, chocolate cream cookies, oatmeal cookies, gluten free cookies, crackers, yogurts, puddings and a label for 1/2 cup of milk for a Resident #61. A surveyor confirmed this finding with the Interim Food Service Director, at the time of the observation.",2020-09-01
88,ORONO COMMONS,205031,117 BENNOCH RD,ORONO,ME,4473,2018-05-10,812,D,0,1,D1U111,"Based on observations and interviews the facility failed to allow pans to air dry before stacking on a shelf. In addition, the facility failed to ensure the kitchenette area on the Riverview unit was maintained in a clean and sanitary manner on 1 of 4 days of survey (5/7/18) Findings: On 5/7/18 at 11:15 a.m. during the initial tour of the kitchen, a surveyor and the Interim Food Service Director (FSD) observed pans wet stacked on the shelf located in the kitchen. The FSD identified the pans as 3 - shallow 6 pans, and 2 - shallow 3rd pans (they were immediately removed from use). On 5/7/18 at 12:45 p.m. a surveyor observed the microwave and refrigerator located in the kitchenette area on the Riverview unit was heavily soiled with splattered food/liquids. At 1:00 p.m. a surveyor confirmed with the Interim FSD that the microwave, and the refrigerator was heavily soiled.",2020-09-01
89,ORONO COMMONS,205031,117 BENNOCH RD,ORONO,ME,4473,2017-06-12,282,D,1,0,1HKG11,"> Based on record review and interviews, the facility failed to ensure that a resident's care plan was being followed in the area of Restorative Range of Motion (ROM) for 2 of 7 sampled residents reviewed (#3 and #6). Findings: 1. Resident #3's care plan, dated 5/15/17, directed the staff to provide range of motion to the resident's bilateral legs due to functional decline. There was no documentation in the resident's record to indicate staff provided range of motion to the resident's legs between 6/1/17 and 6/12/17. On 6/12/17 at 2:30 p.m., the surveyor confirmed with the Nurse Manager that there was no evidence that range of motion was provided to the resident. 2. Resident #6's care plan, dated 5/3/17, directed staff to provide passive range of motion (PROM) to the resident's right and left upper and lower extremities, 10 repetitions each twice daily. The documentation indicated that Resident #6 received PROM on 4/1/17 for 5 minutes, twice on 4/12/17 for 10 minutes and 5 minutes, 5/26/17 for 15 minutes, 6/1/17 for 10 minutes, and twice on 6/10/17 for 10 minutes each time. The resident received PROM for a total of 3 out of 60 shifts in April, (YEAR), on 1 out of 62 shifts in May, (YEAR), and on 2 out of 24 shifts in June, (YEAR). On 6/12/17 at 4:10 p.m., the surveyor confirmed with the Nurse Manager that Resident #6 did not receive PROM as required by her Restorative Nursing Program.",2020-09-01
90,ORONO COMMONS,205031,117 BENNOCH RD,ORONO,ME,4473,2017-06-12,309,E,1,0,1HKG11,"> Based on record review and interview, the facility failed to ensure that the clinical record for 4 of 7 sampled residents (#1, #2, #3 and #6) reviewed for bathing/showers and range of motion was complete, accurate, and consistent with the resident plan of care. Findings: 1. The facility's shower schedule indicated Resident #1 was scheduled to receive a shower on Mondays. Documentation indicated Resident #1 did not receive a shower or bath from 5/8/17 until 6/1/17. Documentation indicated that Resident#1 has not received a bath again since 6/1/17. In an interview with the surveyor on 6/12/17 at 10:55 a.m., Resident #1 indicated that he/she would like to have a shower but had not been offered one. 2. The facility's shower schedule indicated Resident #2 was scheduled to receive a shower on Wednesday evenings. Documentation indicated Resident #2 did not receive a shower or bath from 5/11/17 through 5/24/17, and in June, the resident received a bath on Saturday, 6/3/17 only. In an interview with the surveyor on 6/12/17 at 9:50 a.m., Resident #2 indicated that he/she would like to have a shower but had not been offered one. 3. The facility's shower schedule indicated Resident #6 was scheduled to receive a shower on Friday evenings. Documentation indicated Resident #6 received 1 shower on Sunday, 4/9/17 and did not receive a shower again until Monday, 5/15/17. 4. Resident #3's care plan, dated 5/15/17, directed the staff to provide range of motion to the resident's bilateral legs due to functional decline. There was no documentation in the resident's record to indicate staff provided range of motion to the resident's legs between 6/1/17 and 6/12/17. On 6/12/17 at 2:30 p.m., the surveyor confirmed with the Nurse Manager that there was no evidence that range of motion was provided to Resident #3. 4. Resident #6's care plan, dated 5/3/17, directed staff to provide passive range of motion (PROM) to the resident's right and left upper and lower extremities, 10 repetitions each twice daily. The documentation indicated that Resident #6 received PROM on 4/1/17 for 5 minutes, twice on 4/12/17 for 10 minutes and 5 minutes, 5/26/17 for 15 minutes, 6/1/17 for 10 minutes, and twice on 6/10/17 for 10 minutes each time. The resident received PROM for a total of 3 out of 60 shifts in April, (YEAR), on 1 out of 62 shifts in May, (YEAR), and on 2 out of 24 shifts in June, (YEAR). On 6/12/17 at 4:10 p.m., in a discussion with the surveyor, the Nurse Manager confirmed that documentation indicated Resident #6 did not receive PROM as required by her Restorative Nursing Program, and that Residents #1, #2, and #6, had not received regular baths or showers as had been scheduled.",2020-09-01
91,ORONO COMMONS,205031,117 BENNOCH RD,ORONO,ME,4473,2017-06-12,514,B,1,0,1HKG11,"> Based on record review and interview, the facility failed to ensure that the clinical record for 4 of 7 sampled residents (#1, #2, #3 and #6) reviewed for bathing/showers and range of motion was complete, accurate, and consistent with the resident plan of care. Findings: 1. The facility's shower schedule indicated Resident #1 was scheduled to receive a shower on Mondays. Documentation indicated Resident #1 did not receive a shower or bath from 5/8/17 until 6/1/17. Documentation indicated that Resident#1 has not received a bath again since 6/1/17. In an interview with the surveyor on 6/12/17 at 10:55 a.m., Resident #1 indicated that he/she would like to have a shower but had not been offered one. 2. The facility's shower schedule indicated Resident #2 was scheduled to receive a shower on Wednesday evenings. Documentation indicated Resident #2 did not receive a shower or bath from 5/11/17 through 5/24/17, and in June, the resident received a bath on Saturday, 6/3/17 only. In an interview with the surveyor on 6/12/17 at 9:50 a.m., Resident #2 indicated that he/she would like to have a shower but had not been offered one. 3. The facility's shower schedule indicated Resident #6 was scheduled to receive a shower on Friday evenings. Documentation indicated Resident #6 received 1 shower on Sunday, 4/9/17 and did not receive a shower again until Monday, 5/15/17. 4. Resident #3's care plan, dated 5/15/17, directed the staff to provide range of motion to the resident's bilateral legs due to functional decline. There was no documentation in the resident's record to indicate staff provided range of motion to the resident's legs between 6/1/17 and 6/12/17. On 6/12/17 at 2:30 p.m., the surveyor confirmed with the Nurse Manager that there was no evidence that range of motion was provided to Resident #3. 4. Resident #6's care plan, dated 5/3/17, directed staff to provide passive range of motion (PROM) to the resident's right and left upper and lower extremities, 10 repetitions each twice daily. The documentation indicated that Resident #6 received PROM on 4/1/17 for 5 minutes, twice on 4/12/17 for 10 minutes and 5 minutes, 5/26/17 for 15 minutes, 6/1/17 for 10 minutes, and twice on 6/10/17 for 10 minutes each time. The resident received PROM for a total of 3 out of 60 shifts in April, (YEAR), on 1 out of 62 shifts in May, (YEAR), and on 2 out of 24 shifts in June, (YEAR). On 6/12/17 at 4:10 p.m., in a discussion with the surveyor, the Nurse Manager confirmed that documentation indicated Resident #6 did not receive PROM as required by her Restorative Nursing Program, and that Residents #1, #2, and #6, had not received regular baths or showers as had been scheduled.",2020-09-01
92,ORONO COMMONS,205031,117 BENNOCH RD,ORONO,ME,4473,2019-07-31,600,E,1,0,UEYP11,"> Based on observations, interviews and record reviews, the facility failed to provide adequate supervision to protect residents from resident to resident altercations for 8 of 8 residents reviewed for abuse who currently reside on their Homestead Unit. (#1, #2, #3, #4, #5, #6, #7 and #8) Findings: 1. On 3/7/19 at 8:15 a.m., Resident #4 was sitting in the living room and Resident #1 began yelling out. Resident #4 told Resident #1 loudly to be quite a few times. Resident #1 got up and slapped Resident #4 on the right shoulder. Documentation indicates that Resident #4 was very upset, and staff redirected Resident #1 away from Resident #4. Interventions in place at the time of the altercation are documented as observation, oversight and redirection. 2. On 3/7/19 at 8:30 a.m. Resident #1 approached Resident #3 who was standing in the dining room doorway and started yelling at him/her. Resident #3 yelled back at Resident #1 resulting in Resident #1 hitting Resident #3 on the upper arm. Residents were redirected by staff. Interventions in place at the time of the altercation are documented as observation, oversight and redirection. 3. On 3/7/19 at 8:45 a.m. Resident #1 approached Resident #2 who was sitting in the dining room and grabbed his/her right hand and started squeezing and twisting their fingers. Resident #2 began hollering. Residents were redirected by staff. Interventions in place at the time of the altercation are documented as observation and oversight. 4. On 3/24/19 at 9:30 a.m. staff heard Resident #1 and Resident #5 yelling at each other. Staff came out of the office and saw Resident #1 punch Resident #5 in the face with his/her fist. Resident #5 then punched Resident #1 then grabbed his/her neck area and pushed him/her to the floor. Staff intervened and assisted each resident to a different area. Interventions in place at the time of the altercation is to redirect away from the other residents when agitated and to an appropriate activity. 5. On 3/25/19 at 7:30 p.m. Resident #6 told staff that Resident #1 came into his/her room and slapped him/her in the face. There are no interventions listed as in place at the time of this altercation. 6. On 3/31/19 at 3:30 p.m. staff alerted charge nurse that Resident #7 was crying and had stated that Resident #1 had punched him/her in the nose. Interventions listed as in place are to monitor residents while in common area and dining room. Resident will be given snack/drink in the afternoon, so while waiting for meal, behaviors will be at a minimum. 7. On 4/4/19 at 4:30 p.m. staff heard yelling; they found Resident #8 and Resident #1 in the hallway with Resident #8 having wrapped his/her arms around Resident #1's neck. Staff released Resident #8's hands from Resident #1 neck and was redirected to another area. Interventions in listed in place are observation and redirection. 8. On 7/30/19 during an anonymous interview with a family member they stated that they are not very well supervised, they just don't have enough people to watch everyone, they have so many behaviors that at times they expect us the visitors to pitch in and help keep an eye on them. Which we do, we try to keep them all occupied especially if we don't see any staff around, and it doesn't matter if it's during the day or in the evening. It makes me nervous when I leave I just don't know who will watch over my loved one. 9. On 7/31/19 during an anonymous interview with a staff member they stated that Sometimes we didn't have the staff to provide the 1:1 that Resident #1 would have needed to watch them close enough. Resident #1 always yelled, and he/she was supposed to have 1:1, but due to a call out there was no 1:1 available. 10. On 7/31/19 at 10:30 a.m. during a surveyor's observations of the Homestead unit, it was noted that 1 staff member left the facility with a resident for an appointment and 1 staff was off the unit for lunch leaving 4 staff members were observed, when the surveyor asked staff who was monitoring the first part of the unit near the entrance door, (where 3 residents were notedly looking to leave the unit, and were pushing on the door and arguing with each other regarding opening the door), during this time there was no staff observed on that section of the unit. they stated the staff that left for the appointment was the one scheduled for that area and was not replaced and usually they are not replaced leaving that part of the unit unsupervised until they return. During review of the facilities incident accidents for the months prior to the above resident to resident altercations (11/1/18 to 3/31/19) documentation reflects that Resident #1 was the aggressor in 15 of those altercations. There was a total of 31 resident to resident altercations during that time frame. Review of the reports submitted to the Division of Licensing and Certification for Abuse; Resident to Resident altercations dating from 11/1/18 to 7/4/19, there were 54 reports of Abuse; Resident to Resident altercations. On 7/31/19 at 11:00 a.m. a surveyor confirmed during an interview with the Center Nurse Executive the lack of supervision for Resident#1 who was involved as the aggressor for 6 out of the 7 resident to resident altercations being investigated with 3 of the incidents occurring within a half our time span on 3/7/19.",2020-09-01
93,ORONO COMMONS,205031,117 BENNOCH RD,ORONO,ME,4473,2019-07-31,604,D,1,0,UEYP11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on observation, record review and interviews, the facility failed to complete an assessment for the prior use of a restraint and failed to obtain a physician order [REDACTED].#10). Finding: On 7/30/19 at 11:35 a.m., a surveyor observed Resident #10 sitting on a pummel cushion in his/her wheelchair. On 7/30/19 during an anonymous interview with a staff member it was stated that the pummel cushion helps keep him/her in their chair. On 7/30/19 at 11:45 a.m. during an interview with the charge nurse it was stated that the chair cushion is to help remind him/her to stay sitting, it helps him/her sit up straight in the chair. I don't think we have an order for [REDACTED]. Documentation in Resident #10's clinical record did not indicate that the resident had a restraint in place. There was no evidence in the clinical record of an assessment prior to the application of the pummel cushion restraint. There was no evidence of a physician order [REDACTED]. On 7/31/19 at 12:45 p.m., in an interview with the surveyor, the Rehabilitation Manager, stated that Resident #10 was not assessed for the use of the pummel cushion and that nursing must have placed it in his/her chair. On 7/31/19 at 1:00 p.m. a surveyor confirmed during in an interview with the Center Nurse Executive that Resident #10 did not have an assessment nor an order for [REDACTED].>",2020-09-01
94,ORONO COMMONS,205031,117 BENNOCH RD,ORONO,ME,4473,2019-07-31,657,D,1,0,UEYP11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on record review and interview, the facility failed to ensure a care plan was updated to reflect the resident's current use of a restraint for 1 of 10 residents reviewed for Abuse (#10). Finding: On 7/30/19 during a tour of the Homestead unit, a surveyor observed a resident sitting in a wheelchair with a pummel cushion in place. On 7/30/19 during 2 anonymous interviews with a surveyor it was stated that the pummel cushion helps keep him/her in their chair. On 7/30/19 at 11:45 a.m. during an interview with the charge nurse it was stated that the pummel cushion is to help remind him/her to stay sitting, it helps him/her sit up straight in the chair. I don't think we have an order for [REDACTED]. Review of Resident #10's care plan with a revision date of 7/4/19 indicated the care plan was not updated to address the use of the pummel cushion restraint. On 7/31/19 at 1:00 p.m. a surveyor confirmed during in an interview with the Center Nurse Executive that Resident #10 did not have an assessment or an order for [REDACTED].",2020-09-01
95,ORONO COMMONS,205031,117 BENNOCH RD,ORONO,ME,4473,2019-07-31,684,E,1,0,UEYP11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on record review and interview, the facility failed to follow Physician orders [REDACTED].#8, and #9). Findings: 1. On 7/31/19, a review of Resident #8's clinical record was completed. Resident #8 was admitted to Orono Commons on 4/1/19 with admission orders [REDACTED]. Review of the clinical record and the Electronic Medication Administration Record [REDACTED]. On 7/31/19 at 12:54 p.m., a surveyor confirmed with the Center Nurse Executive that Resident #8 did not receive their [MEDICATION NAME] as ordered. 2. On 7/31/19 a review of Resident #9's clinical record was completed. Resident #8 had a written physician order [REDACTED]. Review of the EMAR indicates that Resident #9 did not receive his/her medication as ordered. On 7/31/19 at 11:58 a.m. a surveyor confirmed during an interview with the Center Nurse Executive that Resident #9 did not receive their medication as ordered.",2020-09-01
96,ORONO COMMONS,205031,117 BENNOCH RD,ORONO,ME,4473,2019-07-31,760,E,1,0,UEYP11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on closed record review and interviews, the facility failed to ensure 1 of 10 sampled residents was free of a significant medication error (#9). Finding: On 7/31/19 during a review of Resident #9's clinical record and the Electronic Medication Administration Record [REDACTED]. The EMAR indicates on 7/9/19 [MEDICATION NAME] (antipsychotic medication) 25 mg po at bedtime for anxiety/depression for 7 days until finished then start 50 mg on 7/16/19 was entered into their system instead of the [MEDICATION NAME] resulting in Resident #9 receiving 7 doses of [MEDICATION NAME] 25 mg from 7/9/19 to 7/15/19 without a physician's orders [REDACTED]. On 7/31/19 at 11:58 a.m. a surveyor confirmed with the Center Nurse Executive that Resident #9 did receive [MEDICATION NAME] 25 mg instead of [MEDICATION NAME] 25 mg for a total of 7 doses from 7/9/19 to 7/15/19.",2020-09-01
97,ORONO COMMONS,205031,117 BENNOCH RD,ORONO,ME,4473,2019-08-20,552,D,1,0,RVHI11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on record reviews and interviews, the facility failed to obtain informed consent for treatment with a psychoactive medication including the risks and benefits of treatment for 1 of 3 sampled residents reviewed for psychoactive medication use (#1). Finding: Resident #1 was sent to Eastern Maine Medical Center (EMMC) on 8/13/19 for an evaluation due to increased agitation. EMMC discharge report dated 8/13/19 had a physician's orders [REDACTED]. Review of resident #1's physician progress notes [REDACTED]. Review of the Medication Administration Record [REDACTED]. Resident #1's medical record lacked evidence that he/she and/or responsible family member was informed of the risks and the benefits of treatment with psychoactive medication and lacked evidence that consent was given for treatment with this medication. On 8/20/19 at 1:27 p.m., in an interview with a surveyor, Resident #1, confirmed that the facility did not informed him/her of the risks and benefits of [MEDICATION NAME] or had given consent to use stating, No, I don't. I don't want it. I don't want them to change my head, it's my right. In addition, Resident #1 was unaware that on 8/18/19 he/she received the psychoactive medication. On 8/20/19 at 2:32 p.m., a surveyor confirmed the finding in an interview with the Nurse Practice Educator.",2020-09-01
98,ORONO COMMONS,205031,117 BENNOCH RD,ORONO,ME,4473,2019-08-20,656,D,1,0,RVHI11,"> Based on record review, observations, and interview, the facility failed to implement a care plan in the area of skin care for 1 of 4 sampled residents (#1). Findings: 1. Resident #1's care plan initiated on 7/19/19, indicates the he/she is at risk for skin breakdown related to frail fragile skin, incontinence, informed refusal to aspects of care, limited mobility, moisture/excessive perspiration, shear/friction risks with interventions to apply barrier cream with each cleaning and utilize turn sheet to assist resident with turning/positioning to reduce friction/shear. On 8/20/19 at approximately 9:55 a.m., a surveyor observed perineal care for Resident #1. The Certified Nursing Aid (CNA) and Registered Nurse (RN) assisted Resident #1 into bed using a Hoyer lift. Once in bed, Resident #1 was assisted in turning to his/her right side by the CNA pushing his/her left hip over, not utilizing a turn sheet. In addition, surveyor observed the CNA finish perineal care and apply a brief without applying a barrier cream after cleaning. On 8/21/19 at 3:10 p.m., a surveyor confirmed the above findings via telephone interview with the Administrator.",2020-09-01
99,ORONO COMMONS,205031,117 BENNOCH RD,ORONO,ME,4473,2019-08-20,758,D,1,0,RVHI11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on record review and interview the facility failed to ensure an as needed (prn) [MEDICAL CONDITION] medication met the required 14-day limit for 1 of 3 residents reviewed for psychoactive medications (Resident #1). Finding: 1. A review of Resident #1's medical record indicted a Physician order [REDACTED]. Review of the Medication Administration Record [REDACTED]. In addition, the facility failed to clarify the order with the residents physician for a 14 day limit and failed to inform the resident of the risks and benefits of the medication. On 8/20/19 at 12:56 p.m., in an interview with the Nurse Practice Educator, the surveyor confirmed the above findings.",2020-09-01
100,ORONO COMMONS,205031,117 BENNOCH RD,ORONO,ME,4473,2019-10-09,623,B,0,1,U94M11,"**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record reviews and interviews, the facility failed to provide written transfer/discharge notices to resident representatives for facility-initiated transfer/discharges for 2 of 2 sampled residents that were transferred or discharged to an acute care facility (Resident #6 and #60). Findings: 1. Resident #6's clinical record was reviewed and documentation indicated the Resident #6 was transferred to an acute care hospital on [DATE]. Resident #6's notice was documented that information was provided by phone to the Resident Representative. The clinical record lacked evidence that the facility issued a written discharge/transfer notice to the Resident Representative. 2. Resident #60's clinical record was reviewed and documentation indicated the Resident #60 was transferred to an acute care hospital on [DATE]. Resident #60's notice was documented verbal Power of Attorney. The clinical record lacked evidence that the facility issued a written discharge/transfer notice to the Resident Representative. On 10/8/19 at 2:07 p.m., during an interview with a surveyor, the Director of Social Services stated that she is unsure who mails a copy of the transfer/discharge notice to the Resident Representative. At 10:00 a.m., during an interview with a surveyor, the Licensed Social Worker stated that she does not mail the transfer/discharge notices but a copy goes to the Business Office. At 10:09 a.m., during an interview with the Center Executive Director, the surveyor confirmed this finding. At 10:41 a.m., during an interview with a surveyor, the Administrator stated that the facility's practice is to read the notice to the Resident Representative and they are not mailing out a written copy of this notice. The surveyor further confirmed this finding at this time.",2020-09-01